The World Bank Report No: ISR6457 Implementation Status & Results Congo, Democratic Republic of DRC Health Sector Rehabilitation Support Project (P088751) Public Disclosure Copy Operation Name: DRC Health Sector Rehabilitation Support Project (P088751) Project Stage: Implementation Seq.No: 15 Status: ARCHIVED Archive Date: 24-Oct-2012 Country: Congo, Democratic Republic of Approval FY: 2006 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Health Ministry Key Dates Board Approval Date 01-Sep-2005 Original Closing Date 30-Jun-2010 Planned Mid Term Review Date Last Archived ISR Date 24-Mar-2012 Effectiveness Date 13-Apr-2006 Revised Closing Date 30-Jun-2014 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to ensure that the target population of selected health zones has access to, and use, a well-defined package of quality essential health services. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Expand Access and Utilization of a Proven Package of Essential Health Services to Selected Districts 193.50 and Health Zones Boost Malaria Control Intervention 103.30 Strengthen Capacity for Oversight and Evidence-based Management of the Health System 30.20 Project Coordination 4.00 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status Overview The third Additional Financing (AF 3) in an amount of US$75 million was approved by the World Bank Board of Executive Directors on June 27, 2012. The Grant Agreement between the Government of the Democratic Republic of Congo and the World Bank was signed on July 30, 2012. AF 3 aims to build on the original project activities to support the provision of essential health services (EHS), with a particular focus on reproductive health services including family planning, as well as HIV/AIDS and nutrition. The project closing date has been Page 1 of 10 The World Bank Report No: ISR6457 further extended to June 30, 2014. This leaves approximately 18 months for implementation of the AF 3 activities. The original project completed its activities in December 2011 and was fully disbursed as of July 31, 2012. While target set for December 2011 have practically been met by the fourth quarter of 2011, first quarter of 2012 saw an overall decline in the progress of key indicators. This was due to lack of inputs and nonpayment of incentives to health administrations Public Disclosure Copy and health workers caused by: (i) a financing gap for support to EHS between January and July 2012; and (ii) while funding to cover this gap was made available by the ongoing two AFs, there were some delays in the disbursement of these funds. Distribution of a total of 9.4 million long-lasting insecticide bednets (LLINs) was completed in April 2012. The acquisition of ACTs and Rapid Tests is advancing well (although with delay) and distribution is expected to be completed by October. AF 1 also supported provision of Essential Health Services between the period January-July 2012 to bridge the financing gap resulting from delays in Boars approval of AF 3. The second Additional Financing (AF 2) for poliomyelitis control progressed well with signature of US$7.9 million contract with UNICEF for the acquisition of vaccines and cold chain equipment. Distribution is expected to be completed in the next three months. Preparation of the final survey for the impact evaluation of the Katanga PBF Pilot is currently ongoing. The survey and the analysis should be completed by the end of November 2012. The Canadian Trust Fund to support capacity strengthening in budget preparation in the health sector (CAD 4.4 million) has so far achieved the following results: (i) development of a tool specific for health sector in preparing a Medium Term Expenditure Framework; (ii) training of results-based management and budget programming for health sector officials; (iii) support and supervision to provincial levels in the utilization of MTEF tools and projections for budget envelope; and (iv) support to preparation of 2013 budget (at central level) and defense of the budget proposal. Implementation of these activities allowed for identification of existing bottlenecks in the budget execution, which will be reflected in the subsequent activities. Next steps will be to decentralize these activities through support to provincial levels in their process of budgeting and developing MTEF. Locations Country First Administrative Division Location Planned Actual Congo, Dem Rep Not Entered Yambuku Congo, Dem Rep Not Entered Yamaluka Congo, Dem Rep Not Entered Wema Congo, Dem Rep Not Entered Tunda Congo, Dem Rep Not Entered Sous-Region de la Tshuapa Public Disclosure Copy Congo, Dem Rep Not Entered Sandoa Congo, Dem Rep Not Entered Samba Congo, Dem Rep Not Entered Pweto Congo, Dem Rep Not Entered Pimu-Lendo Congo, Dem Rep Province du Sud-Kivu Ntondo Congo, Dem Rep Not Entered Sous-Region de la Mongala Page 2 of 10 The World Bank Report No: ISR6457 Country First Administrative Division Location Planned Actual Congo, Dem Rep Not Entered Mondombe Public Disclosure Copy Congo, Dem Rep Not Entered Mondombe Congo, Dem Rep Not Entered Mompono Congo, Dem Rep Not Entered Mankanza Congo, Dem Rep Province du Maniema Province du Maniema Congo, Dem Rep Not Entered Lusangi Congo, Dem Rep Not Entered Lukolela Congo, Dem Rep Not Entered Lolo Congo, Dem Rep Not Entered Lisala Congo, Dem Rep Not Entered Lingomo Congo, Dem Rep Not Entered Kilwa Congo, Dem Rep Not Entered Kapanga Congo, Dem Rep Not Entered Kalamba Congo, Dem Rep Not Entered Kafakumba Congo, Dem Rep Not Entered Kabambare Congo, Dem Rep Not Entered Ikela Congo, Dem Rep Not Entered Djombo Congo, Dem Rep Not Entered Djolu Public Disclosure Copy Congo, Dem Rep Not Entered Bumba Congo, Dem Rep Not Entered Bosondjo Congo, Dem Rep Not Entered Bosanga Congo, Dem Rep Not Entered Bongandanga Congo, Dem Rep Not Entered Bokungu Congo, Dem Rep Not Entered Binga Congo, Dem Rep Not Entered Befale Page 3 of 10 The World Bank Report No: ISR6457 Congo, Dem Rep Not Entered Sakania Congo, Dem Rep Not Entered Lukafu Public Disclosure Copy Congo, Dem Rep Not Entered Kisenge Congo, Dem Rep Not Entered Kipushi Congo, Dem Rep Not Entered Kasongo Congo, Dem Rep Province du Katanga Kasenga Congo, Dem Rep Not Entered Kasaji Congo, Dem Rep Not Entered Kafubu Congo, Dem Rep Not Entered Dilolo Congo, Dem Rep Not Entered Yumbi Congo, Dem Rep Not Entered Wangata Congo, Dem Rep Not Entered Pendjwa Congo, Dem Rep Not Entered Oshwe Congo, Dem Rep Not Entered Nioki Congo, Dem Rep Ville de Kinshasa Ndjili Congo, Dem Rep Not Entered Mushie Congo, Dem Rep Not Entered Monkoto Congo, Dem Rep Not Entered Monieka Congo, Dem Rep Not Entered Mimia Public Disclosure Copy Congo, Dem Rep Not Entered Ville de Mbandaka Congo, Dem Rep Province de l' Equateur Mbandaka Congo, Dem Rep Not Entered Mampoko Congo, Dem Rep Not Entered Lotumbe Congo, Dem Rep Not Entered Lilanga Congo, Dem Rep Province de Bandundu Kwamouth Page 4 of 10 The World Bank Report No: ISR6457 Congo, Dem Rep Not Entered Kiri Congo, Dem Rep Ville de Kinshasa Ville de Kinshasa Public Disclosure Copy Congo, Dem Rep Not Entered Kikimi Congo, Dem Rep Not Entered Kibombo Congo, Dem Rep Ville de Kinshasa Kibanseke I Congo, Dem Rep Not Entered Irebu Congo, Dem Rep Not Entered Inongo Congo, Dem Rep Not Entered Ingende Congo, Dem Rep Not Entered Iboko-Bolombi Congo, Dem Rep Not Entered Iboko-Bolombi Congo, Dem Rep Not Entered Sous-Region de l' Equateur Congo, Dem Rep Not Entered Bosobe Congo, Dem Rep Not Entered Bomongo Congo, Dem Rep Not Entered Bolomba Congo, Dem Rep Not Entered Bolobo Congo, Dem Rep Not Entered Bolenge Congo, Dem Rep Not Entered Bokungu Congo, Dem Rep Not Entered Bokoro Congo, Dem Rep Not Entered Boende Public Disclosure Copy Congo, Dem Rep Not Entered Bobangi Congo, Dem Rep Not Entered Bikoro Congo, Dem Rep Not Entered Basankusu Congo, Dem Rep Not Entered Bandjow-Moke Congo, Dem Rep Ville de Kinshasa Masina Congo, Dem Rep Ville de Kinshasa Kimbanseke II Page 5 of 10 The World Bank Report No: ISR6457 Results Project Development Objective Indicators Public Disclosure Copy Indicator Name Core Unit of Measure Baseline Current End Target Total number of new polio cases reported Number Value 98.00 0.00 30.00 quarterly Date 31-Dec-2010 30-Jun-2012 30-Jun-2013 Comments No new cases reported nationwide in the last quarter. AFPs reported monthly through surveillance system. % of children immunized with OPV3 Percentage Value 74.00 89.00 89.00 Date 31-Dec-2010 31-Mar-2012 30-Jun-2013 Comments From routine data provided by National Vaccination program. % of pregnant women who received 2 doses of Percentage Value 49.00 49.00 70.00 IPT during last pregnancy (NEW Date 31-Dec-2010 30-Jun-2012 30-Jun-2013 Comments Based on HMIS, based on IP reports Q2 2012 % of pregnant women who slept under ITN the Percentage Value 43.00 28.00 74.00 night before Date 31-Dec-2010 31-Dec-2011 30-Jun-2013 Comments The baseline was collected by Unicef is currently conducting UNICEF on a relatively small a coverage survey and the sample of households. results will be available before December 2012. % of under-five children who slept under an Percentage Value 38.00 28.00 70.00 insecticide-treated net (ITN) the night before Date 31-Dec-2010 31-Dec-2011 30-Jun-2013 Comments The baseline was collected by Unicef is currently conducting UNICEF on a relatively small a coverage survey and the sample of households. results will be available before Public Disclosure Copy December 2012. % women 15-49 years new users of family Percentage Value 2.00 5.00 11.00 planning in project districts Date 01-Jul-2007 30-May-2012 30-Jun-2014 Comments Population-weighted average from HMIS, reported by Target revised following of collection of HMIS data by Implementing Partners Q1 approval of the third AF. contracted M&E firm 2012. Decrease due to lack of end-2007 is 1.3%. Estimate inputs but original end target from household survey of December 2011 achieved. end-2007 by M&E firm is not usable. Estimate of current Page 6 of 10 The World Bank Report No: ISR6457 use of modern contraceptives (ie. new users and previous adopters) in rural areas of DRC from 2007 DHS is 3.3%. Public Disclosure Copy % deliveries assisted by qualified personnel in Percentage Value 47.00 72.00 85.00 project districts Date 01-Jul-2007 31-Mar-2012 30-Jun-2014 Comments from Implementing Partner from HMIS, reported by Target revised following reports Population-weighed Implementing Partners Q1 approval of the third AF. average from collection of 2012. Decrease due to lack of HMIS data by contracted inputs but original end target M&E firm end-2007 is 50%. of December 2011 achieved. Estimate from end-2007 household survey by M&E firm is 65%. % children 0-11 months vaccinated with DPT3 Percentage Value 54.00 76.00 90.00 in project districts Date 01-Jul-2007 31-Mar-2012 30-Jun-2014 Comments Population-weighted average from HMIS, reported by Target revised following from collection of HMIS data Implementing Partners Q1 approval of the third AF. in the project districts 2012. Decrease due to lack of end-2007 by thecontracted inputs but original end target M&E firm is 47%. Estimate of December 2011 achieved. from end-2007 household The MOU signed with survey in project districts by UNICEF in 2012 for M&E firm is 60% acquisition of vaccines and cold chains will help resolve the problem of stock-outs. Per capita annual curative consultation rate in Number Value 0.19 0.38 0.45 project districts Date 01-Jul-2007 31-Mar-2012 30-Jun-2014 Comments from HMIS, reported by Target revised following Implementing Partners Q1 approval of the third AF. 2012. Slight decrease due to lack of inputs Public Disclosure Copy Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target number of health personnel who received Number Value 10269.00 13000.00 training Date 01-Jul-2007 30-May-2012 30-Jun-2014 Comments Based on IP quarterly reports. Based on IP quarterly reports, Health Facility surveys Page 7 of 10 The World Bank Report No: ISR6457 % of female direct beneficiaries ( over total Percentage Value 0.00 51.50 60.00 number of beneficiaries) Date 01-Jul-2007 31-Dec-2011 31-Dec-2011 Comments DHS data Public Disclosure Copy Direct project beneficiaries Number Value 0.00 7.11 25.50 Date 01-Jul-2007 30-May-2012 30-Jun-2014 Comments millions millions Female beneficiaries Percentage Value 0.00 51.50 54.00 Sub Type Supplemental percentage disbursement of NGOs contracts Percentage Value 0.00 98.00 100.00 Date 01-Jul-2007 30-May-2012 31-Aug-2012 Comments percentage of pregnant women who receive Percentage Value 63.00 79.00 75.00 antenatal care Date 31-Dec-2007 30-May-2012 31-Dec-2011 Comments HMIS, IP report Q4 2011 Children immunized Number Value 250000.00 1580000.00 5780000.00 Date 01-Jul-2007 31-May-2011 30-Jun-2013 Comments 2007 estimate Million, cumulative. No cumulative since 2007 updated data available in target zones yet. Health facilities constructed, renovated, and/or Number Value 0.00 810.00 850.00 equipped Date 01-Jul-2007 30-May-2012 30-Jun-2014 Comments cumulative, updated based on Based on quarterly IP reports IP reports Q4 2011 % of reports including malaria control activities Percentage Value 75.00 completed at health zone level and transmitted Date 30-Jun-2014 to provincial level. Comments No data available now Public Disclosure Copy Long-lasting insecticide-treated malaria nets Number Value 11800000.00 11800000.00 purchased and/or distributed Date 30-Jun-2012 30-Jun-2013 Comments Distribution completed % of under-five children with fever and treated Percentage Value 60.00 with ACTs Date 30-Jun-2013 Comments No updated data available in target zones. DHS is foreseen in December 2012 Page 8 of 10 The World Bank Report No: ISR6457 Households that possess at least one or more Number Value 9.20 50.20 75.00 bed nets Date 01-Jul-2007 30-May-2012 30-Jun-2013 Comments No updated data available in Public Disclosure Copy target zones. mass distribution will start in April. 2012 DHS (planned for December 2012) will provideupdated information. % of provincial and health zones with adequate Percentage Value 60.00 60.00 75.00 vaccines storage, cold chain, and capacity Date 31-May-2011 31-May-2011 30-Jun-2013 Comments No updated data available in target zones. But regular shortages of all antigens during several months affected the whole country % of provincial and health zones with OPV in Percentage Value 70.00 90.00 95.00 stock and without stock shortage Date 01-Jul-2007 31-May-2011 30-Jun-2014 Comments No updated data available in target zones. But regular shortages of all antigens during several months affected the whole country % of children 6-59 months of age having Percentage Value 83.00 83.00 95.00 received Vitamin A Date 31-May-2011 30-Jun-2014 Comments No updated data available in target zones but Vit A capsules have been supplied by UNICEF in most facilities Public Disclosure Copy Data on Financial Performance (as of 18-Sep-2012) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P088751 IDA-H1820 Effective 01-Sep-2005 18-Oct-2005 13-Apr-2006 30-Jun-2010 30-Jun-2013 P088751 IDA-H6380 Effective 20-Dec-2010 02-Feb-2011 02-May-2011 30-Jun-2013 30-Jun-2013 P088751 IDA-H7170 Effective 28-Jun-2011 28-Jul-2011 25-Oct-2011 30-Jun-2013 30-Jun-2013 P088751 IDA-H7500 Not Effective 17-Jul-2012 30-Jul-2012 30-Jun-2014 30-Jun-2014 P088751 TF-95892 Effective 25-Feb-2010 01-Mar-2010 01-Mar-2010 31-Dec-2011 30-Jun-2013 Page 9 of 10 The World Bank Report No: ISR6457 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P088751 IDA-H1820 Effective USD 150.00 150.00 0.00 149.95 3.09 100.00 P088751 IDA-H6380 Effective USD 80.00 80.00 0.00 72.12 8.54 90.00 Public Disclosure Copy P088751 IDA-H7170 Effective USD 30.00 30.00 0.00 17.84 10.67 59.00 P088751 IDA-H7500 Not Effective USD 75.00 75.00 0.00 0.00 71.26 0.00 P088751 TF-95892 Effective USD 0.42 0.86 0.00 0.50 0.36 58.00 Disbursement Graph Key Decisions Regarding Implementation Following signature of the Grant Agreement for the third Additional Financing (AF 3) on July 30, 2012, the government is expected to take necessary actions to ensure a swift Public Disclosure Copy effectiveness and start-up of this financing. Restructuring History Level two Approved on 15-Jan-2010 Related Projects P122251-DRC Malaria Control Additional Financing to Health Sector Rehab Support, P125677-DRC Polio Control Additional Financing to Health Sector Rehab Support, P126088- DRC Additional Financing Primary Health Care Page 10 of 10