Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Development Support (P101160) Health Sector Development Support (P101160) AFRICA | Burundi | Health, Nutrition & Population Global Practice | IBRD/IDA | Specific Investment Loan | FY 2009 | Seq No: 16 | ARCHIVED on 30-Jun-2017 | ISR27678 | Implementing Agencies: Ministry of Finance Key Dates Key Project Dates Bank Approval Date:09-Jun-2009 Effectiveness Date:30-Sep-2009 Planned Mid Term Review Date:-- Actual Mid-Term Review Date:01-Dec-2014 Original Closing Date:30-Dec-2012 Revised Closing Date:30-Jun-2017 Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase the use of a defined package of health services by pregnant women and children under the age of five. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) To increase the use of a defined package of health services by pregnant women, children under the age of five and couples ofreproductive age. Components Name Component 1 - Increased financing for a redefined free package of services:(Cost $67.55 M) Component 2 - Strengthening capacity of the Ministry of Public Health and entities involved in RBF:(Cost $17.25 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Satisfactory Overall Risk Rating  Substantial  Substantial 6/30/2017 Public Disclosure Copy Page 1 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Development Support (P101160) Implementation Status and Key Decisions This is the final ISR for the HSDSP Project (P101160). The PDO rating is maintained as Satisfactory based on the performance of both PDO and intermediate indicators. Significant results were achieved during implementation of the FHC/RBF program according to household surveys - MPA, 2009 and 2012; and National Health Information System. Overall, the implementation progress is upgraded to “Satisfactory”. The project disbursements have increased substantially in the last six months with the remaining balance ($1.96 million) expected to be utilized by June 30. Moreover, almost all project activities, including safeguards, have been completed or are at a final stage of implementation. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  High  High Macroeconomic  --  Substantial  Substantial Sector Strategies and Policies  --  Moderate  Moderate Technical Design of Project or Program  --  Moderate  Moderate Institutional Capacity for Implementation and Sustainability  --  Substantial  Substantial Fiduciary  --  Moderate  Moderate Environment and Social  --  Moderate  Moderate Stakeholders  --  Moderate  Moderate Other  --  --  -- Overall  --  Substantial  Substantial Results Project Development Objective Indicators PHINDPDOTBL  Average number of visits to a health provider by children under the age of 5 (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.68 2.20 2.20 2.30 Date 31-Dec-2009 05-Oct-2016 05-Oct-2016 30-Jun-2017 Comments This indicator is captured through household survey only. The indicator of 2.2 was reached in 2012. The ongoing DHS (awaiting data) will provide the final indicator for 2016. 6/30/2017 Public Disclosure Copy Page 2 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Development Support (P101160) Achievement rate: 83% PHINDPDOTBL  Children immunized (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 297,780.00 328,533.00 328,533.00 359,930.00 Date 31-Dec-2009 24-Oct-2016 24-Oct-2016 30-Jun-2017 Comments Not yet achieved (Achievement rate: 49%) PHINDPDOTBL  Children immunized - under 12 months against DTP3 (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 297,780.00 322,560.00 322,560.00 341,030.00 Date 31-Dec-2009 24-Oct-2016 24-Oct-2016 31-Aug-2014 PHINDPDOTBL  Number of pregnant women living with HIV who received antiretrovirals to reduce the risk of Mother To Child Transmission (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,582.00 3,885.00 5,026.00 3,600.00 Date 31-Dec-2009 24-Oct-2016 31-Mar-2017 30-Jun-2017 Comments 2016 data. Source: PNLS Annual Report, March 2017. Target surpassed (Achievement rate: 171%) 6/30/2017 Public Disclosure Copy Page 3 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Development Support (P101160) PHINDPDOTBL  Coverage of prenatal care services for pregnant women (at least 3 visits) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 59.40 66.50 66.50 65.50 Date 31-Dec-2009 24-Oct-2016 24-Oct-2016 30-Jun-2017 Comments Target surpassed. However, according to preliminary 2016 data, the indicator may have gone down slightly. Achievement rate: 116% PHINDPDOTBL  Pregnant women receiving antenatal care during a visit to a health provider (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 415,799.00 529,662.00 529,662.00 549,564.00 Date 31-Dec-2009 24-Oct-2016 24-Oct-2016 30-Jun-2017 Comments Not yet achieved. However, target almost reached (Achievement rate: 85%). 2016 data not yet available. PHINDPDOTBL  Percentage of births assisted by skilled personnel (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 64.40 78.40 78.40 86.20 Date 31-Dec-2009 24-Oct-2016 24-Oct-2016 30-Jun-2017 Comments Nearly reached (85% in 2016, according to preliminary 2016 data). It is a very ambitious target that has been changed (augmented) during the project life. Achievement rate: 64% 6/30/2017 Public Disclosure Copy Page 4 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Development Support (P101160) PHINDPDOTBL  Direct project beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 2,210,111.00 2,263,154.00 2,210,111.00 Date 31-Dec-2009 24-Oct-2016 31-Mar-2017 30-Jun-2017 Comments Target surpassed (Achievement rate: 102%). PHINDPDOTBL  Female beneficiaries (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1,360,523.00 1,394,317.00 1,393,176.00 PHINDPDOTBL  Contraceptive prevalence rate (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 19.80 37.40 37.40 34.85 Date 31-Dec-2009 24-Oct-2016 24-Oct-2016 30-Jun-2017 Comments Target surpassed (Achievement rate: 117%). PHINDPDOTBL  Pregnant/lactating women, adolescent girls and/or children under age five-reached by basic nutrition services (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 0.00 Date 31-Dec-2009 -- -- 31-Dec-2009 6/30/2017 Public Disclosure Copy Page 5 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Development Support (P101160) Comments Core Multi-indicators: Pregnant/lactating women, adolescent girls and/or children under age five-reached by basic nutrition services (above): not included in the RF. This is a CRI indicator which has been included just now in the RF by OPCS (was not part of the project’s RF): This CRI indicator is meant to capture the results from the 2 nutrition indicators being tracked below: - Children between the age of 6 and 59 months receiving Vitamin A supplementation: Target almost achieved (Achievement rate: 97%). - Children under age five treated for moderate or severe acute malnutrition: Not achieved (Achievement rate: 70%) because UNICEF and WFP have reduced significantly their support. PHINDPDOTBL  Children between the age of 6 and 59 months receiving Vitamin A supplementation (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1,265,275.00 1,652,052.00 1,651,266.00 1,664,878.00 Date 31-Dec-2009 24-Oct-2016 31-Mar-2017 30-Jun-2017 PHINDPDOTBL  Children under age five treated for moderate or severe acute malnutrition (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 87,170.00 58,307.00 58,307.00 83,081.00 Date 31-Dec-2009 24-Oct-2016 31-Mar-2017 30-Jun-2017 Overall Comments Despite the critical political and macroeconomic situation in 2015 and 2016, out of 11 PDO indicators, 6 have been achieved/surpassed, 2 are nearly achieved (more than 80% of the target already achieved in 2015) and 3 are not expected to be reached. Intermediate Results Indicators 6/30/2017 Public Disclosure Copy Page 6 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Development Support (P101160) PHINDIRITBL  Percent of public and non-profit health facilities offering the free package of services through the RBF system (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.90 96.80 94.00 100.00 Date 31-Mar-2010 24-Oct-2016 31-Mar-2017 30-Jun-2017 Comments Not achieved but target nearly reached (Achievement rate: 88%). Certain faith based health facilities terminated their contracts because of delays in payments due to the crisis in 2015-2016. PHINDIRITBL  Births (deliveries) attended by skilled health personnel (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 188,135.00 368,092.00 368,092.00 364,090.00 Date 31-Dec-2009 24-Oct-2016 24-Oct-2016 30-Jun-2017 Comments Target surpassed (Achievement rate: 102%). PHINDIRITBL  Number of couple-years of contraceptive protection using modern methods (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 228,082.00 528,029.00 631,204.00 734,520.00 Date 31-Dec-2009 24-Oct-2016 24-Oct-2016 30-Jun-2017 Comments Very ambitious target not achieved but good progress (almost 3 times the baseline!). Achievement rate: 80% 6/30/2017 Public Disclosure Copy Page 7 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Development Support (P101160) PHINDIRITBL  Percentage of health facilities that did run out of essential drugs in the previous month (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.10 5.10 4.90 Date 31-Mar-2010 24-Oct-2016 24-Oct-2016 30-Jun-2017 Comments Target almost reached (Achievement rate: 96%). PHINDIRITBL  Percentage of health facilities that have a Head with A2 Level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 62.00 62.00 60.00 Date 31-Dec-2009 24-Oct-2016 24-Oct-2016 30-Jun-2017 Comments Target surpassed (Achievement rate: 103%). Overall Comments Out of the 5 IR Indicators, all are achieved/surpassed or nearly achieved. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P101160 IDA-H4880 Closed USD 25.00 24.99 0.01 26.06 0.00 104% P101160 IDA-H8080 Effective USD 25.00 25.00 0.00 22.50 0.52 90% P101160 TF-12526 Closed USD 14.80 14.79 0.01 14.79 0.00 100% P101160 TF-13043 Effective USD 20.00 20.00 0.00 19.46 0.54 97% 6/30/2017 Public Disclosure Copy Page 8 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Development Support (P101160) Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P101160 IDA-H4880 Closed 09-Jun-2009 07-Jul-2009 30-Sep-2009 30-Dec-2012 31-Aug-2014 P101160 IDA-H8080 Effective 23-Oct-2012 10-Dec-2012 08-Apr-2013 31-Dec-2018 30-Jun-2017 P101160 TF-12526 Closed 25-Jul-2012 25-Jul-2012 12-Oct-2012 31-Aug-2014 31-Aug-2014 P101160 TF-13043 Effective 10-Dec-2012 10-Dec-2012 08-Apr-2013 31-Dec-2018 30-Jun-2017 Cumulative Disbursements Restructuring History Level 2 Approved on 30-Jan-2015 ,Level 2 Approved on 26-Mar-2015 ,Level 2 Approved on 02-Feb-2017 Related Project(s) P126742-Health Sector Development Support - Additional Financing ,P131919-Second Additional Financing Burundi Health Sector Development Support Project 6/30/2017 Public Disclosure Copy Page 9 of 9