The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) AFRICA | Madagascar | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2018 | Seq No: 4 | ARCHIVED on 14-Oct-2019 | ISR38489 | Implementing Agencies: Unité de Programme National de Nutrition Communautaire (UPNNC), Ministry of Finance, Unité de Coordination des Projets (UCP) - Ministry of Public Health Key Dates Key Project Dates Bank Approval Date: 12-Dec-2017 Effectiveness Date: 13-Apr-2018 Planned Mid Term Review Date: 15-Jul-2020 Actual Mid-Term Review Date: Original Closing Date: 31-Jul-2023 Revised Closing Date: 31-Jul-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase utilization of an evidence-based package of reproductive, maternal and child health and nutrition (RMCHN) interventions and improve key nutrition behaviors known to reduce stunting in targeted regions and to provide immediate and effective response to an eligible crisis or emergency. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Scale up coverage and utilization of the RMCHN minimum package:(Cost $54.00 M) Strengthen capacity to manage and deliver the RMCHN minimum package:(Cost $29.50 M) Project Management, Capacity Building and Operations Support:(Cost $6.50 M) Contingent Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The project became effective on April 13, 2018. The third implementation support mission after project effectiveness took place from July 8-19, 2019. In addition, periodic bi-monthly meetings were organized to discuss issues and find relevant solutions to ensure the implementation of the agreed upon annual work plan for 2019 is on track. 40% of 2019 planned activities are completed and 30% are under implementation. This has 10/14/2019 Page 1 of 7 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) translated to an improved disbursement rate from 16% in April to 24% end July 2019 for a period of 15 months (25% period) of implementation from the Effectiveness date. On overall Implementation Progress: despite the effort made in planning and coordinating interventions with stakeholders and other partners, the implementation of project interventions was hampered by the need to prioritize the management of the measles outbreak from October 2018 to the first quarter of 2019. This epidemic occurred in a context of poor routine immunization performance with a WHO-UNICEF estimate of 58% national measles vaccine (VAR) coverage. Since the project contribute to the immunization program, the task team will support the client to increase coverage of quality immunization services (routine and outreach interventions) in the project regions of intervention. The task team worked with the client on an updated chronogram of project activities till the end of 2019, which will be closely monitored by the Bank team. mpaTable Multiphase Programmatic Approach (MPA) Status mpaTableBody The implementation of this first MPA project is picking up pace within the first four intervention areas (regions of Itasy, Vakinankaratra, Amoron'Imania and Haute Matsiatra). The Government has improved their technical and fiduciary management as evidenced by 40% of planned activities completed and 30% under implementation. This has translated to an improved disbursement rate from 16% in April to 24% end July 2019 for a period of 15 months (25% period) of implementation from the Effectiveness date. More than 70% of the planned activities are implemented, reflecting an improvement in clients'ownership and proactivity. The community platform is fully functional, allowing beneficiary access to the integrated health and nutrition services package at all the 2775 community sites and 465 primary health care supported by the project. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Sustainability High High High Fiduciary Substantial Substantial Substantial Environment and Social Low Low Low Stakeholders Low Low Low Other Low Low Low Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes 10/14/2019 Page 2 of 7 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) Improve key nutrition behaviors known to reduce stunting in targeted regions IN00742008 ►Percentage of infants 0-5 months of age exclusively breastfed (by sex) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 48.50 48.50 48.50 58.50 Date 11-Sep-2017 25-Jul-2018 25-Jul-2018 31-Jul-2023 No changes in this indicator were expected in this reporting period. Value will be updated when the MICS6 Comments: data for the project areas of intervention is available. IN00742010 ►Percentage of women receiving any IFA tablets at last pregnancy (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 59.00 59.00 59.00 74.00 Date 11-Sep-2017 25-Jul-2018 25-Jul-2018 31-Jul-2023 No changes in this indicator were expected in this reporting period. Value will be updated when the MICS6 Comments: data for the project areas of intervention is available. IN00742021 ►Percentage of children 6-23 months of age with minimum meal frequency (by sex) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.90 3.90 3.90 13.90 Date 11-Sep-2017 25-Jul-2018 25-Jul-2018 31-Jul-2023 No changes in this indicator were expected in this reporting period. Value will be updated when the MICS6 Comments: data for the project areas of intervention is available. Increase utilization of package of RMCHN interventions known to reduce stunting in targeted regions IN00742007 ►Percentage of children 6-59 months of age receiving vitamin A supplementation within the past 6 months (by sex) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 49.50 49.50 49.50 64.50 Date 11-Sep-2017 25-Jul-2018 25-Jul-2018 31-Jul-2023 No changes in this indicator were expected in this reporting period. Value will be updated when the MICS6 Comments: data for the project areas of intervention is available. IN00742009 ►Number of facility-based deliveries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 141,300.00 141,300.00 159,587.00 290,000.00 Date 11-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 10/14/2019 Page 3 of 7 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) Value as of end May 2019 and covers the period Aug 2018-May 2019. 2019 target surpassed at 106% Comments: Intermediate Results Indicators by Components Project Management, Capacity Building and Operations Support IN00742024 ►Grievances responded to and/or resolved within the stipulated service standard for response times (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 95.00 75.00 Date 21-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 2019 target surpassed Comments: Strengthen capacity to manage and deliver the RMCHN minimum package IN00742023 ►Number of community health and nutrition workers trained by the project (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 6,160.00 10,100.00 Date 11-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 2019 target surpassed Comments: IN00742025 ►Percentage of community health and nutrition workers achieving satisfactory score on the community service delivery indicator (SDI) score (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 75.00 Date 11-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 No changes in the indicator were expected in this reporting period. Data will be updated when the SDI Comments: 2020 report is available. IN00742027 ►Percentage of providers at the primary care facilities achieving satisfactory score on the service delivery indicator (SDI) score (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.90 1.90 1.90 75.00 Date 11-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 No changes in the indicator were expected in this reporting period. Data will be updated when the SDI Comments: 2020 report is available. IN00742030 ►Percentage of primary care facilities providing monthly activity reports on time (Percentage, Custom) 10/14/2019 Page 4 of 7 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) Baseline Actual (Previous) Actual (Current) End Target Value 34.00 34.00 79.00 80.00 Date 11-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 2019 target achieved surpassed Comments: IN00742032 ►Percentage of communes that organized at least 1 CoSan meeting in the past 6 months (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 29.00 80.00 Date 11-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 2019 target achieved at 78% Comments: Scale up coverage and utilization of the RMCHN minimum package IN00742022 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 256,118.00 2,871,000.00 Date 19-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 Value as of end May 2019 and covers the period Aug 2018-May 2019. 2019 target achieved at 35% Comments: IN00742026 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 37,187.00 171,000.00 Date 19-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 IN00742028 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 218,931.00 2,700,000.00 Date 19-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 IN00742029 ►Number of women receiving ANC during the first 3 months of pregnancy (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 81,200.00 81,200.00 89,906.00 140,000.00 Date 11-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 Value from Aug 2018 - end May 2019. 2019 target achieved at 90%. Comments: IN00742031 10/14/2019 Page 5 of 7 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) ►Number of functioning community sites (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 2,775.00 5,050.00 Date 11-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 Value as of end May 2019. 2019 target achieved at 135%. Comments: IN00742033 ►Number of severe acute malnutrition (SAM) cases treated in the outpatient SAM treatment program (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 870.00 870.00 2,038.00 8,000.00 Date 21-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 Value as of end May 2019. End year target achieved at 45% Comments: IN00742034 ►Number of primary care facilities having tracer medications in stock (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 296.00 296.00 296.00 700.00 Date 11-Sep-2017 25-Jul-2018 31-May-2019 31-Jul-2023 No changes in the indicator were expected in this reporting period. Data will be updated when the SDI Comments: 2020 report is available. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P160848 IDA-D2570 Effective USD 80.00 80.00 0.00 19.12 58.61 25% P160848 TF-A6102 Effective USD 10.00 10.00 0.00 2.28 7.72 23% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P160848 IDA-D2570 Effective 12-Dec-2017 14-Dec-2017 13-Apr-2018 31-Jul-2023 31-Jul-2023 P160848 TF-A6102 Effective 12-Dec-2017 14-Dec-2017 13-Apr-2018 31-Jul-2023 31-Jul-2023 Cumulative Disbursements 10/14/2019 Page 6 of 7 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 10/14/2019 Page 7 of 7