The World Bank Report No: ISR16291 Implementation Status & Results Burundi Health Sector Development Support (P101160) Public Disclosure Copy Operation Name: Health Sector Development Support (P101160) Project Stage: Implementation Seq.No: 11 Status: ARCHIVED Archive Date: 08-Nov-2014 Country: Burundi Approval FY: 2009 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 09-Jun-2009 Original Closing Date 30-Dec-2012 Planned Mid Term Review Date 30-Sep-2011 Last Archived ISR Date 26-Mar-2014 Effectiveness Date 30-Sep-2009 Revised Closing Date 31-Dec-2018 Actual Mid Term Review Date 03-Oct-2011 Project Development Objectives Health Sector Development Support (P101160) Project Development Objective (from Project Appraisal Document) To increase the use of a defined package of health services by pregnant women, children under the age of five and couples ofreproductive age. Has the Project Development Objective been changed since Board Approval of the Program? ● Yes No Component(s) Component Name Component Cost Component 1 - Increased financing for a redefined free package of services 67.55 Component 2 - Strengthening capacity of the Ministry of Public Health and entities involved in RBF 17.25 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Highly Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview The original financing of US$ 25 million (IDA H4880) as well as the first AF of US$ 14.8 million (HRITF12526) have closed with almost 100% disbursement on August 31, 2014. The project is currently implementing its second AF, for a total amount of US$ 45 million (IDAH8080, $25 million and HRITF13043, $20 million). The project is due to close on December 31, 2018; but the possibility of advancing the project closing date is being discussed given the higher rate of disbursement than initial projections. A second phase of RBF to be implemented beyond 2016, oriented towards strategic purchasing, is currently under discussion with the government. A mid-term review is planned by December 2014 to assess the progress towards achievement of PDOs (in view of stagnating or declining indicators) and implementation status Page 1 of 8 The World Bank Report No: ISR16291 (including safeguards, procurement and FM issues) as well as to inform decisions with regard to a possible preparation of next phase of the project (whether in the form of a new operation or another additional financing). A health financing strategy is being prepared under government leadership building on the health care financing study that has been coordinated by the World Bank, completed and Public Disclosure Copy validated by all the stakeholders in June 2014. Locations Country First Administrative Division Location Planned Actual Burundi Not Entered Makamba Province Burundi Not Entered Bururi Province Burundi Not Entered Muramvya Province Burundi Not Entered Gitega Province Burundi Not Entered Ruyigi Province Burundi Not Entered Cankuzo Province Burundi Not Entered Karuzi Province Burundi Not Entered Bubanza Province Burundi Not Entered Cibitoke Province Burundi Not Entered Ngozi Province Burundi Not Entered Kayanza Province Burundi Not Entered Muyinga Province Burundi Not Entered Kirundo Province Burundi Not Entered Rutana Province Public Disclosure Copy Burundi Not Entered Province de Mwaro Burundi Not Entered Bujumbura Mairie Province Burundi Not Entered Bujumbura Rural Province Results Project Development Objective Indicators Page 2 of 8 The World Bank Report No: ISR16291 Indicator Name Core Unit of Measure Baseline Current End Target Average number of visits to a health provider Number Value 1.68 2.20 2.00 by children under the age of 5 Date 31-Dec-2009 31-Aug-2014 31-Dec-2018 Public Disclosure Copy Comments Source: Updated value from End target achieved. Updated Target updated to reflect the 2009 Paquet Minimum de data from 2012 HH Survey new closing date. Service (PMS 1) household (PMS II). (HH) survey. Alternative proxy indicator " number of under- five children curative care visits to hospitals and health centers" (RBF program) Children immunized (number) Number Value 297780.00 335211.00 365561.00 Date 31-Dec-2009 31-Aug-2014 31-Dec-2018 Comments Source: HMIS report 2009, From 2013 HMIS report (not Source: HMIS report indicator measured is yet validated); decreased by ''children under 12 months 0.3% against DTP3 /Pentavalent 3 (number)'' . Alternative proxy indicator is '' children completely vaccinated'' (RBF program) Children immunized - under 12 months against Number Value 297780.00 333298.00 341030.00 DTP3 (number) Sub Type Date 31-Dec-2009 15-Jun-2013 31-Aug-2014 Breakdown Comments Source: HMIS report 2009, Updated data will be Source: HMIS report. This indicator measured is confirmed once the 2012 indicator will not be updated ''children under 12 months HMIS report is validated. as it was eliminated in the first against DTP3 /Pentavalent 3 Data from the HH survey AF (effectiveness date (number)'' as DTP3 is no shows a slight increase: from October 2012). longer used in Burundi since 86.8%in 2009 to 87.1% in 2006 but cannot modify the 2012. wording as it is a core indicator. Alternative proxy of Public Disclosure Copy RBF program '' children who are completely vaccinated'' is 25,287. Page 3 of 8 The World Bank Report No: ISR16291 Number of pregnant women living with HIV Number Value 1582.00 3084.00 2710.00 who received antiretrovirals to reduce the risk Date 31-Dec-2009 31-Aug-2014 31-Dec-2018 of Mother To Child Transmission Comments Source: HMIS report 2009. Source: CNLS report 2013; Source: HMIS report. Target Public Disclosure Copy Alternative proxy indicator end target achieved will be revisited during mid- from PBF program is term review (MTR) in 2015. ''pregnant women with HIV under ARV treatment'' Coverage of prenatal care services for Percentage Value 59.40 60.50 70.50 pregnant women (at least 3 visits) Date 31-Dec-2009 31-Aug-2014 31-Dec-2018 Comments Source: National HMIS 2013 report. Decreased Source: HMIS Reproductive Health program by 0.8%. (NRHP). Alternative proxy indicator is ''number of standard prenatal consultations (3per pregnancy) at hospitals and health centers (RBF Program) Pregnant women receiving antenatal care Number Value 415799.00 511821.00 537318.00 during a visit to a health provider (number) Date 31-Dec-2009 31-Aug-2014 31-Dec-2018 Comments Source: HMIS report 2009. HMIS 2013 report. CPN1. Source: HMIS Indicator newly added under AF1. Percentage of births assisted by skilled Percentage Value 64.40 78.40 69.00 personnel Date 31-Dec-2009 31-Aug-2014 31-Dec-2018 Comments Source: 2009 PMS survey. End target achieved. Updated Source: Household survey Data from NRHP report 2009 data from 2012 HH Survey for ''percentage of births (PMS II) taking place in health facilities '' was 56.3%. Alternative proxy indicator is ''number of births occurring at hospitals Public Disclosure Copy and health centers based (RBF Program data) Direct project beneficiaries Number Value 0.00 2058327.00 2273188.00 Date 31-Aug-2014 31-Dec-2018 Comments Source: HMIS 2013 (pregnant The target direct project women calculated at 5.0% of beneficiaries are those total population; children eligible for the country's Free Health Care program; (i.e. Page 4 of 8 The World Bank Report No: ISR16291 under five calculated at 17.9% pregnant women and children of total population) under five); the program covers nationwide. Female beneficiaries Percentage Value 0.00 1271901.00 1368232.00 Public Disclosure Copy Sub Type Supplemental Contraceptive prevalence rate Percentage Value 19.80 31.70 24.00 Date 31-Dec-2009 31-Aug-2014 31-Dec-2018 Comments Source: 2012 Household Source: Household survey. survey (PMS II) Target to be revisited during MTR. Pregnant/lactating women, adolescent girls Number Value 0.00 0.00 0.00 and/or children under age five-reached by Date 31-Dec-2009 31-Dec-2009 basic nutrition services (number) Comments This indicator is not included This indicator is not included This indicator is not included in the project Result in the project Result in the project Result Framework Framework Framework Children between the age of 6 and 59 months Number Value 1265275.00 1550538.00 1709804.00 receiving Vitamin A supplementation (number) Sub Type Date 31-Dec-2009 31-Aug-2014 31-Dec-2018 Breakdown Comments Source: HMIS and Campaign HMIS and Campaign Data data. Newly added with AF 2. 2013. Decreased by 9.3% compared to HMIS Campaign Data 2012 which was at 1 710 261. Children under age five treated for moderate or Number Value 87170.00 77375.00 93500.00 severe acute malnutrition (number) Sub Type Date 31-Dec-2009 31-Aug-2014 31-Dec-2018 Breakdown Comments HMIS, indicator newly added PRONIANUT report 2013. PRONIANUT report 2018 with AF 2 Decreased by 6.8% compared to PRONIANUT report 2012 data which was at 83 058. Public Disclosure Copy Intermediate Results Indicators Page 5 of 8 The World Bank Report No: ISR16291 Indicator Name Core Unit of Measure Baseline Current End Target Percentage of health facilities that did not run Percentage Value 53.30 55.14 60.00 out of essential drugs in the previous three Date 31-Mar-2010 31-Aug-2014 31-Dec-2018 Public Disclosure Copy months Comments (1) The source for the above RBF 2013 report. This Target updated to reflect the is the March 2010 health indicator has remained the second AF. facilities survey (FOSA). It same from previous year: includes hospitals as well as 55.03% (RBF 2012 report). health centers. (2) Alternative proxy measures are available based on the quality checklist evaluation done (every quarter) under the national RBF program, but using different methodologies than for the health facility survey. (More details are given in the Aide Memoire for the Midterm Review.) These alternative measures show percentage values of 34% for health centers and 20.3% for hospitals, in the Aprill-June 2010 quarter (the first quarter of the national RBF program). Percent of public and non-profit health facilities Percentage Value 50.90 99.26 85.00 offering the free package of services through Date 31-Mar-2010 31-Aug-2014 31-Dec-2018 the RBF system Comments Source: March 2010 health Official records from MoH and Target updated to reflect the facilities survey (FOSA) from the national RBF second AF. program. Percentage of facilities that have had an Percentage Value 48.09 100.00 100.00 internal verification visit in the previous six Date 31-Mar-2010 31-Aug-2014 31-Dec-2018 months Comments Source: March 2010 health Source: official records from Public Disclosure Copy facility survey (FOSA). MoH. "internal" visit is defined here as a visit by a verification team outside of thehealth facility. Page 6 of 8 The World Bank Report No: ISR16291 Percentage of health facilities that have Percentage Value 75.50 77.90 83.00 qualified personnel (at least an A2 nurse) in Date 31-Mar-2010 29-Nov-2013 31-Dec-2018 rural areas Comments Source: March 2010 health Data unavailable. To be Public Disclosure Copy facility survey (FOSA) updated upon completion of the health facility survey. Number of health facilities that have had an Number Value 0.00 0.00 150.00 external verification visit (cumulative) Date 31-Mar-2013 31-Aug-2014 31-Dec-2018 Comments MoH: no contract available in Target to be revisited during last six mounths) due to delay the MTR. in the procurement process Births (deliveries) attended by skilled health Number Value 188135.00 335049.00 431602.00 personnel (number) Date 31-Dec-2009 31-Aug-2014 31-Dec-2018 Comments HMIS 2009 Error in the ISR system: Source: HMIS 82908 should have been 304 403 in the previous (HMIS 2012) Number of couple-years of contraceptive Number Value 228082.00 668040.00 447274.00 protection using modern methods Date 31-Dec-2009 31-Aug-2014 31-Dec-2018 Comments Source: HMIS, Indicator End target achieved, HMIS Source: HMIS. newly added with AF 2. 2013 (previous 523243, HMIS 2012) Data on Financial Performance (as of 09-Oct-2014) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised 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 31-Dec-2018 P101160 TF-12526 Closed 25-Jul-2012 25-Jul-2012 12-Oct-2012 31-Aug-2014 31-Aug-2014 Public Disclosure Copy P101160 TF-13043 Effective 10-Dec-2012 10-Dec-2012 08-Apr-2013 31-Dec-2018 31-Dec-2018 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P101160 IDA-H4880 Closed USD 25.00 25.00 0.00 26.06 0.02 104.00 P101160 IDA-H8080 Effective USD 25.00 25.00 0.00 1.62 23.82 6.00 P101160 TF-12526 Closed USD 14.80 14.80 0.00 14.80 0.00 100.00 P101160 TF-13043 Effective USD 20.00 20.00 0.00 0.00 20.00 0.00 Page 7 of 8 The World Bank Report No: ISR16291 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation The original IDA financing of $25 million and the first AF (HRITF) of US$ 14.8 million have closed with 100% disbursement rate on August 31, 2014. The project is currently implementing its second AF, for a total amount of US$ 45 million (IDA and HRITF combined). The project is due to close in December 31, 2018. In parallel, to support the expanded nutrition focus of the project, the government and the World Bank are currently implementing a PBF nutrition Impact Evaluation. Restructuring History There has been no restructuring to date. Related Projects P126742-Health Sector Development Support - Additional Financing, P131919-Second Additional Financing Burundi Health Sector Development Support Project Public Disclosure Copy Page 8 of 8