Public Disclosure Copy The World Bank Implementation Status & Results Report South Sudan Health Rapid Results Project (P127187) South Sudan Health Rapid Results Project (P127187) AFRICA | South Sudan | Health, Nutrition & Population Global Practice | Special Financing | Investment Project Financing | FY 2012 | Seq No: 14 | ARCHIVED on 29-Apr-2019 | ISR36600 | Implementing Agencies: Ministry of Finance and Economic Planning, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 13-Apr-2012 Effectiveness Date: 02-Aug-2012 Planned Mid Term Review Date: 15-Jun-2015 Actual Mid-Term Review Date: 15-Jun-2015 Original Closing Date: 31-Oct-2014 Revised Closing Date: 30-Sep-2017 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Objectives of the Project are: (i) to improve the delivery of High Impact Primary Health Care Services in Upper Nile andJonglei states; and (ii) to strengthen the coordination, monitoring and evaluation capacities of the Ministry of Health. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Delivery of high impact Primary Health Care services in Jonglei and Upper Nile State:(Cost $23.00 M) Component 2: Capacity development of MOH at the national level:(Cost $5.00 M) Component 3:Pharmaceutical Commodities:(Cost $15.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Unsatisfactory Overall Risk Rating High High Implementation Status and Key Decisions Despite significant implementation challenges, project contributed to the delivery of key health services the targeted areas until project closure. A new health operation (Provision of Essential Health Services Project) has been recently approved by the Board and became effective in March 4/29/2019 Page 1 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report South Sudan Health Rapid Results Project (P127187) 2019. The project will continue supporting the delivery of high impact services in South Sudan, with a particular focus on the former states of Upper Nile and Jonglei. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- High High Macroeconomic -- High High Sector Strategies and Policies -- High High Technical Design of Project or Program -- High High Institutional Capacity for Implementation and Sustainability -- High High Fiduciary -- High High Environment and Social -- High High Stakeholders -- High High Other -- -- -- Overall -- High High Results PDO Indicators by Objectives / Outcomes To improve the delivery of High Impact Primary Health Care IN00689431 ►Number of children under 12 months immunized against DPT3 (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 16,986.00 116,961.00 126,177.00 90,000.00 Date 15-Jun-2011 30-Sep-2018 30-Mar-2019 30-Apr-2019 IN00689432 ►Pregnant women receiving antenatal care during a visit to a health provider (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 21,180.00 192,402.00 204,016.00 150,000.00 Date 15-Jun-2011 30-Sep-2018 30-Mar-2019 30-Apr-2019 IN00689433 4/29/2019 Page 2 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report South Sudan Health Rapid Results Project (P127187) ►Percentage of functional health facilities submitting standardized HMIS monthly reports within one month of the reporting month (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.00 73.00 89.00 75.00 Date 06-Apr-2012 30-Sep-2018 30-Mar-2019 30-Apr-2019 IN00689434 ►Outpatient visits per capita per year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.10 0.35 0.62 0.50 Date 06-Apr-2012 30-Sep-2018 31-Dec-2018 30-Apr-2019 Source: LSTM Quarterly Verification Visit Report (December 2018) for period April-June 2018. The UNICEF report for the period July-October 2018 reports that there 230,957 outpatient consultations to Comments: children under 5 at with an estimated population of children under 5 at 533,786 for Upper Nile and Jonglei, resulting in a per capita outpatient consultation per year for children under 5 of 1.73 visits. IN00689435 ►Percentage of direct beneficieries of which female (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 51.00 53.00 53.00 50.00 Date 02-Apr-2011 30-Sep-2018 30-Mar-2019 30-Apr-2019 Intermediate Results Indicators by Components Component 1: Delivery of high impact Primary Health Care services in Jonglei and Upper Nile State IN00689436 ►Number of children who received measles vaccination 59 months of age (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 97,857.00 161,316.00 171,640.00 150,000.00 Date 15-Jun-2011 30-Sep-2018 30-Mar-2019 30-Apr-2019 IN00689439 ►Children 6-59 months receiving a dose of vitamine A (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 18,074.00 538,796.00 552,975.00 515,000.00 Date 15-Jun-2011 30-Sep-2018 30-Mar-2019 30-Apr-2019 IN00689441 ►Births (deliveries) attended by skilled health personnel (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 4/29/2019 Page 3 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report South Sudan Health Rapid Results Project (P127187) Value 13,827.00 18,995.00 21,439.00 12,000.00 Date 15-Jun-2011 30-Sep-2018 30-Mar-2019 30-Apr-2019 IN00689443 ►Long-lasting insecticide-treated malaria nets purchased and/or distributed (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 126,451.00 2,542,796.00 2,542,796.00 2,600,000.00 Date 06-Apr-2012 23-Dec-2016 23-Dec-2016 30-Apr-2019 Data has not been collected on this indicator since December 2016 Comments: IN00689445 ►Percentage of health facilities having essential drugs at the time of supervisory visit (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 43.00 65.00 80.00 Date 15-Jun-2011 30-Sep-2018 30-Mar-2019 30-Apr-2019 During the period July-September 2018, 45 out of the 69 health facilities (65%) supervised by UNICEF staff had essential drugs at the time of visits. The stock out observed in 35% of the health facilities was due to the delays in the distribution of the buffer stock resulting from the recount exercise requested by the MoH and due to bad weather conditions making supply delivery difficult during the rainy season. Comments: Given both the buffer stock and two batches of IPA pharmaceuticals have been distributed between October and March 2019, the proportion of health facilities with essential medicines has most likely increased significantly and will hopefully be captured in the project ICR report. IN00689446 ►Percentage of children aged 0-59 months living under a LLIN the night before survey (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 34.20 26.80 27.65 40.00 Date 01-Jan-2013 23-Dec-2016 30-Mar-2019 30-Sep-2018 The data from the 2018 LQAS survey estimates coverage at 28.9% for Upper Nile and 26.4% for Jonglei, will be used given it is population-based data. Comments: It should be noted that the LSTM QVV Report completed in December 2018 (covering period April-June 2018) estimates coverage at 88%. IN00689447 ►Percentage of health centres with at least two skilled health workers (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 81.00 80.00 60.00 Date 01-Jan-2013 31-Mar-2018 31-Dec-2018 30-Apr-2019 From the LSTM QVV visits for the period April-June 2018 (report completed December 2018), the percentage of facilities with skilled workers was 80%. The final report from UNICEF notes that 67 health facilities (32%) had at least two qualified workers. As Comments: the LSTM QVV definition and methodology was used to establish the baseline and progress for the indicator, the final QVV report will be used for this ISR, not the UNICEF definition or data. IN00689448 4/29/2019 Page 4 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report South Sudan Health Rapid Results Project (P127187) ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 129,758.00 729,431.00 729,431.00 677,000.00 Date 15-Jun-2011 30-Sep-2018 30-Sep-2018 30-Apr-2019 IN00689449 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 35,007.00 278,734.00 278,734.00 162,000.00 IN00689450 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 97,857.00 171,640.00 180,856.00 150,000.00 Date 15-Jun-2011 30-Sep-2018 30-Mar-2019 30-Apr-2019 IN00689451 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 129,758.00 729,431.00 743,610.00 677,000.00 Date 15-Jun-2011 30-Sep-2018 30-Mar-2019 30-Apr-2019 IN00689452 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 13,827.00 18,995.00 21,439.00 12,000.00 Date 15-Jun-2011 30-Sep-2018 30-Mar-2019 30-Apr-2019 Component 2: Capacity development of MOH at the national level IN00689440 ►Percentage of established Boma/village health committees that feel their feedback related to health committees has been responded to by CHDs and IPs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40.00 Date 27-Jun-2016 05-Dec-2016 05-Dec-2016 30-Apr-2019 Data has not been collected on this indicator since December 2016 Comments: IN00689442 ►Percenatage of health facilities with Boma/village health committees established and meeting at least twice every quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11.20 11.20 40.00 4/29/2019 Page 5 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report South Sudan Health Rapid Results Project (P127187) Date 27-Jun-2016 31-Mar-2018 31-Mar-2018 30-Apr-2019 IN00689444 ►Percentage of health facilities with structured supervision visit (using QSC) within a month before a verification visit (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 25.00 47.10 65.00 55.00 Date 06-Apr-2012 31-Mar-2018 30-Mar-2019 30-Apr-2019 UNICEF final report notes that 137 of health facilities (65%) were supervised by IPs and 94 (44%) were Comments: supervised directly by UNICEF. Component 3:Pharmaceutical Commodities IN00689438 ►Percentage of health facilities having essential drugs at the time of supervisory visit (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 43.80 65.00 80.00 Date 06-Apr-2012 30-Sep-2018 30-Mar-2019 30-Apr-2019 During the period July-September 2018, 45 out of the 69 health facilities (65%) supervised by UNICEF staff had essential drugs at the time of visits. The stock out observed in 35% of the health facilities was due to the delays in the distribution of the buffer stock resulting from the recount exercise requested by the MoH and due to bad weather conditions making supply delivery difficult during the rainy season. Comments: Given both the buffer stock and two batches of IPA pharmaceuticals have been distributed between October and March 2019, the proportion of health facilities with essential medicines has most likely increased significantly and will hopefully be captured in the project ICR report. As such this indicator reports results achieved through Component 1, not Component 3. Overall Comments IR Various sources of data were used to update the Results Framework for the final ISR: (1) UNICEF final report for period July-September 2018 (finalized in March 2019): (2) 2018 LSTM LQAS survey (finalized in December 2018), LSTM Quarterly Verification Visit for period April-June 2018 (finalized in December 2018) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P127187 IDA-54010 Closed USD 10.00 9.99 0.01 9.23 0.00 100% P127187 IDA-D1250 Effective USD 40.00 40.00 0.00 34.29 5.64 86% 4/29/2019 Page 6 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report South Sudan Health Rapid Results Project (P127187) P127187 IDA-H9210 Closed USD 25.00 24.99 0.01 23.70 0.00 100% P127187 TF-12272 Closed USD 28.00 27.94 0.06 27.94 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P127187 IDA-54010 Closed 13-Mar-2014 09-May-2014 09-Sep-2014 31-Oct-2015 31-Mar-2018 P127187 IDA-D1250 Effective 27-Jun-2016 02-Feb-2017 23-Mar-2017 30-Sep-2017 30-Apr-2019 P127187 IDA-H9210 Closed 13-Mar-2014 09-May-2014 09-Sep-2014 31-Oct-2015 31-Mar-2018 P127187 TF-12272 Closed 20-Apr-2012 20-Apr-2012 02-Aug-2012 31-Oct-2014 30-Sep-2017 Cumulative Disbursements Restructuring History Level 2 Approved on 22-Jun-2015 ,Level 2 Approved on 30-Jan-2017 ,Level 2 Approved on 07-Apr-2017 ,Level 2 Approved on 28-Mar-2018 ,Level 2 Approved on 20-Jul-2018 Related Project(s) P146413-South Sudan Health Rapid Results AF ,P156917-South Sudan Health Rapid Results Project AF 4/29/2019 Page 7 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report South Sudan Health Rapid Results Project (P127187) 4/29/2019 Page 8 of 8