The World Bank Report No: ISR15367 Implementation Status & Results Peru PE- (APL2) Health Reform Program (P095563) Public Disclosure Copy Operation Name: PE- (APL2) Health Reform Program (P095563) Project Stage: Implementation Seq.No: 10 Status: ARCHIVED Archive Date: 12-Jul-2014 Country: Peru Approval FY: 2009 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Adaptable Program Loan Implementing Agency(ies): Key Dates Board Approval Date 17-Feb-2009 Original Closing Date 31-Jan-2015 Planned Mid Term Review Date 30-Oct-2012 Last Archived ISR Date 21-Dec-2013 Effectiveness Date 15-Dec-2009 Revised Closing Date 31-Jan-2015 Actual Mid Term Review Date 26-Feb-2013 Project Development Objectives Project Development Objective (from Project Appraisal Document) Framed within the long-term objective of the Health Reform Program (APL in all its phases) to reduce maternal and infant mortality rates in the nine poorest regions of the country (Amazonas, Huanuco, Huancavelica, Ayacucho, Apurimac, Cusco, Cajamarca, Ucayali and Puno); the project development objectives are to: (i) improve family care practices for women (during pregnancy, delivery and breast-feeding), and children under the age of three; (ii) strengthen health services networks with capacity to solve obstetric, neonatal and infant emergencies and to provide comprehensive health services to women (during pregnancy, delivery and breast-feeding) and children under the age of three; and (iii) support MINSA's governance functions of regulation, quality, efficiency and equity for improving the new health delivery model of maternal and child health care in a decentralized environment. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Improving health practices at the household level for women and children under age three in rural 6.00 areas of the nine targeted Regions . Increasing the capacity to provide better maternal and child health services for the poor. 142.30 Public Disclosure Copy Strengthening government capacities to offer more equitable and efficient health system in a 5.20 decentralized environment. Project Coordination, and Monitoring & Evaluation 8.90 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Moderate Page 1 of 5 The World Bank Report No: ISR15367 Implementation Status Overview The Project was approved by the Board on February 17, 2009 and became effective on December 15, 2009. The project was restructured on June 21, 2011, and. A Mid-Term Review (MTR) was conducted in February 2013, in close coordination with the Inter-American Development Bank (IADB), to assess the project status and identify strategies to improve its implementation. Public Disclosure Copy The progress towards achievement of Project Development Objectives (PDO) continues to be satisfactory. All 6 PDO indicators are on track, and three of them already surpassed in 2013 the initial goal set by the project (exclusive breastfeeding, anemia reduction in pregnant women and reduction of neonatal lethality at hospitals). However, the proportion of institutional deliveries in rural areas expected to reach the goal of 78% by 2014, and the prevalence of anemia in children younger than 3 in the nine project regions, remain a challenge. The Project has continued the implementation of its activities under the Strategy for Promotion of Healthy Practices and Environments (EPPES) in 117 districts corresponding to the poorest areas, which has contributed to improve the indicators associated to maternal and child health. The Promotion Strategy for Identification (DIA) is contributing to facilitate the SIS’ identification and affiliation processes, having reached nearly 2 million women in fertile age. Locations Country First Administrative Division Location Planned Actual Peru Not Entered Departamento de Ucayali Peru Not Entered Departamento de Huánuco Peru Not Entered Departamento de Cajamarca Peru Not Entered Departamento de Amazonas Peru Not Entered Departamento de Puno Peru Not Entered Departamento de Huancavelica Peru Not Entered Departamento de Cusco Peru Not Entered Departamento de Ayacucho Peru Not Entered Departamento de Apurímac Public Disclosure Copy Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increase the proportion of pregnant women of Percentage Value 20.00 71.00 45.00 the nine regions with at least 1 prenatal control Date 30-Dec-2005 31-Dec-2012 30-Dec-2013 during the first trismester of pregnancy from Comments Target achieved. Percentage Expecting to be revised in a 20% (2005) to 45% (2013) has increased substantially. restructuring. Page 2 of 5 The World Bank Report No: ISR15367 Increase the proportion of institutional Percentage Value 44.00 78.00 78.00 deliveries in rural areas of the nine selected Date 30-Dec-2005 31-Dec-2012 30-Dec-2013 Regions from 44% (2005) to 78% (2013) Comments The goal of this indicator was Public Disclosure Copy achieved by the end of 2012. Reduce the prevalence of anemia among Percentage Value 69.50 57.00 60.00 children under age 3 in the nine regions from Date 30-Dec-2005 31-Dec-2012 30-Dec-2013 69.5% (2005) to 60% (2013) Comments The goal of this indicator was Expecting to be revised in a achieved by the end of 2012. restructuring. Increase from 64% to 80% the share of Percentage Value 64.00 66.00 80.00 children in the nine selected regions who are Date 30-Dec-2005 31-Dec-2012 30-Dec-2013 exclusively breastfed until 6 months of age Comments Indicator looks like to not be achieved due the increase on the distribution of children prepared aliments by other governmental programs. Reduce the prevalence of anemia among Percentage Value 41.50 35.00 pregnant women in the nine Regions from Date 30-Dec-2005 30-Dec-2013 41.5% (2005) to 35% (2013). Comments Information related to this indicator will expected to be available by the end of 2013. Reduce the hospital lethality rate among Percentage Value 9.50 5.00 neonates in the nine selected Regions from Date 30-Dec-2005 30-Dec-2013 9.5% (2005) to 5% (2013). Comments Information related to this indicator will expected to be produced by the end of 2013. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Component 1: % of SIS affiliated children who Percentage Value 34.00 59.10 66.00 Public Disclosure Copy received growth and development controls Date 30-Dec-2005 31-Dec-2012 30-Dec-2013 (CRED) according to their age Comments Component 2: % of SIS affiliated rural pregnant Percentage Value 37.00 31.00 80.00 women with laboratory tests on hemoglobin, Date 30-Dec-2005 31-Dec-2012 30-Dec-2013 urine and syphilis Comments This indicator has presented low performance due delays in labs construction. Page 3 of 5 The World Bank Report No: ISR15367 Component 2: % of pregnant women under SIS Percentage Value 37.00 88.00 80.00 that receive iron and folic acid supplements Date 30-Dec-2005 31-Dec-2012 30-Dec-2013 Comments This indicator was revised. Expecting to be revised in a Public Disclosure Copy Last date (on 2009) indicated restructuring. 83.00%. So this information update the last register which was not well documented. According the new data, this indicator was achieved and surpassed Component 2: % of cesareans in SIS affiliated Percentage Value 3.00 10.20 5.00 pregnant rural women Date 30-Dec-2005 31-Dec-2013 30-Dec-2013 Comments This indicator has been Expecting to be revised in a achieved and surpassed. restructuring. Component 2: % of health facilities with Percentage Value 0.00 90.00 improvement in infrastructure (minor Date 30-Dec-2005 31-Dec-2012 30-Dec-2013 construction and / new equipment) Comments This Indicator will be removed Component 2: % of women satisfied with the Percentage Value 1.00 74.40 25.00 services in selected facilities by confidence Date 30-Dec-2005 24-Feb-2012 30-Dec-2013 index Comments Target Achieved and surpassed Component 3: % of SIS affiliated households Percentage Value 67.30 56.80 25.00 that make out-of-pocket expenditures in Date 30-Dec-2005 31-Dec-2012 30-Dec-2013 medicines Comments Indicator on track but with low likelihood of initial goal achievement. Component 3: % of references among SIS- Percentage Value 0.00 5.00 affiliated women (during pregnancy and Date 30-Dec-2005 30-Dec-2013 puerperium) and neonates. Comments It was agreed that this Public Disclosure Copy Indicator will be removed. Component 3: Number of accredited health Percentage Value 80.00 169.00 establishements by type of resolution. Date 30-Dec-2005 30-Dec-2013 Comments It was agreed that this Indicator will be removed. Component 3: Number of Management Number Value 0.00 Agreements in place. Date Comments It was agreed that this Indicator will be removed. Page 4 of 5 The World Bank Report No: ISR15367 Data on Financial Performance (as of 25-Mar-2014) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date Public Disclosure Copy P095563 IBRD-76430 Effective 17-Feb-2009 16-Nov-2009 15-Dec-2009 31-Jan-2015 31-Jan-2015 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P095563 IBRD-76430 Effective USD 15.00 15.00 0.00 7.96 7.04 53.00 Disbursement Graph Key Decisions Regarding Implementation Public Disclosure Copy The project has disbursed 53% of loan proceeds as of May 2014. Restructuring History Level two Approved on 21-Jun-2011 Related Projects There are no related projects. Page 5 of 5