Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) Lao PDR Health Governance and Nutrition Development Project (P151425) EAST ASIA AND PACIFIC | Lao People's Democratic Republic | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2015 | Seq No: 5 | ARCHIVED on 27-Jan-2018 | ISR29912 | Implementing Agencies: Lao People's Democratic Republic, Ministry of Health Key Dates Key Project Dates Bank Approval Date:23-Jun-2015 Effectiveness Date:12-Oct-2015 Planned Mid Term Review Date:15-Oct-2018 Actual Mid-Term Review Date:-- Original Closing Date:31-Dec-2020 Revised Closing Date:31-Dec-2020 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project development objective is to help increase coverage of reproductive, maternal and child health, and nutrition services in target areas in Lao PDR. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured)PHRPDODEL The Project development objective is to help increase coverage of reproductive, maternal and child health, and nutrition services in target areas in Lao PDR, and to provide immediate and effective response in case of an Eligible Crisis or Emergency. Components Name Component 1: Health Sector Governance Reform:(Cost $2.00 M) Component 2: Service Delivery:(Cost $30.40 M) Component 3: Nutrition Social and Behavior Change Communication:(Cost $5.20 M) Component 4: Project Management, Monitoring and Evaluation:(Cost $3.80 M) Component 5: Contingent Emergency Response Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Satisfactory 1/27/2018 Page 1 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Satisfactory Overall Risk Rating  Substantial  Substantial Implementation Status and Key Decisions The Health Governance and Nutrition Development Project (HGNDP) is making significant progress towards achievement of Project Development Objectives (PDO). An additional financing (AF) to HGNDP with a total financing of US$15 million equivalent composed of US$ 10 million IDA credit, US$ 1 million from Japan and US$ 4 million from Australia has been signed by the Government of Lao PDR on November 6, 2017. The AF will expand the scope of activities under the HGNDP and will continue to support improvement of reproductive, maternal and child health, and nutrition services in the 14 target provinces. Further, the project has been restructured to reflect (a) modification of the PDO to include standard language reflecting the contingent emergency response component embedded in the project; (b) change in project scope and design to reflect new activities supported through AF; (c) revision of DLIs and Results Framework to reflect changes in some indicator definitions, baselines, and targets; (d) updates to disbursement and implementation arrangements; (e) application of the updated procurement regulations; and (f) minor updates of environmental safeguards. Pending year 1 (2015-2016) disbursement-linked indicators (DLIs) achievements have been resolved with additional information from the provinces and verified though field spot checks by the World Bank team. For year 2 (2016-2017) DLIs,four central level DLI targets have been fully achieved; six provincial level DLIs 1, 2, 3, 4, 5 and 7 have either been fully or partially achieved in all 14 provinces; while remaining three provincial level DLIs 5, 6 and 8 are pending further documentation/ validation. KAP survey data collection have been completed and preliminary results are available which are under review. 1/27/2018 Page 2 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) 1/27/2018 Page 3 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) 1/27/2018 Page 4 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) 1/27/2018 Page 5 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  Substantial  Substantial  Substantial Macroeconomic  Substantial  Substantial  Substantial Sector Strategies and Policies  Substantial  Substantial  Substantial Technical Design of Project or Program  High  High  High Institutional Capacity for Implementation and Sustainability  High  High  High Fiduciary  High  High  High Environment and Social  Moderate  Moderate  Moderate Stakeholders  Moderate  Moderate  Moderate Other  --  --  -- Overall  Substantial  Substantial  Substantial Results Project Development Objective Indicators 1/27/2018 Page 6 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) PHINDPDOTBL  Number of women who deliver with a skilled birth attendant at home or at a health facility (DLI P1). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 40% over Value 61,881.00 73,828.00 74,730.00 baseline Date 01-Oct-2015 31-May-2017 30-Sep-2017 31-Dec-2020 Comments Actual value is based on the most recent data from DHIS2 reporting period October 2016 – September 2017 (preceding 12 months) to allow better tracking of results in between the DLI reporting period. While the DLI measures increase over baseline of each respective province, in the ISR this is reported based on aggregate from all 14 target provinces. Baseline has been revised from 63,380 to 61,881 during the September 2017 restructuring to address: (i) double recording of births; and (ii) reporting home deliveries attended by traditional birth attendant. PHINDPDOTBL  Number of pregnant women who receive 4 Antenatal Care Contacts (DLI P2). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 40% over Value 56,284.00 67,917.00 69,721.00 baseline Date 01-Oct-2015 31-May-2017 30-Sep-2017 31-Dec-2020 Comments Actual value is based on the most recent data from DHIS2 reporting period October 2016 – September 2017 (preceding 12 months) to allow better tracking of results in between the DLI reporting period. While the DLI measures increase over baseline of each respective province, in the ISR this is reported based on aggregate from all 14 target provinces. Baseline revised with restructuring to address: (i) double recording of 4th ANC; (b) recording of each ANC rather than only the 4th ANC; and (iii) lack of verification of data by supervisors during Year 0, based on subsequently reported discrepancies between reported data and logbook. PHINDPDOTBL  Number of women aged 15-49 years who are continued users of long term methods of family planning (DLI P3). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 20% over Value 186,556 TBD 193,111.00 baseline Date 31-May-2017 31-May-2017 30-Sep-2017 31-Dec-2020 1/27/2018 Page 7 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) Comments Indicator definition has been revised during the September 2017 restructuring from "new women aged 15-49 years using longer term family planning methods" to "continued users of long term family planning methods" and the new baseline was reestablished as186,556 women as of May 31 2017. This is a cumulative number for all current continued users of: injectable, implants, IUDs, and sterilization. Current actual value is as of September 2017. PHINDPDOTBL  Number of children 6-11 months who received first dose of Vitamin A. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 123,389.00 53,170.00 113,010.00 140,000.00 Date 31-Dec-2016 30-Jun-2017 31-Dec-2017 31-Dec-2020 Comments This indicator has been newly added at the PDO level and replaced the exclusive breastfeeding indicator which is now moved to intermediate outcome level to reflect availability of routine data captured through DHIS2. The baseline number captures the period January - December 2016. Current actual value is from January – December 2017 (12 months) as reported by DHIS2. This indicator is reported for nationwide (18 provinces). PHINDPDOTBL  Direct project beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 216,532.00 473,205.00 1,400,000.00 Date 01-Oct-2015 31-May-2017 30-Sep-2017 31-Dec-2020 Comments Definition of this indicator was revised during the September 2017 restructuring to better reflect the reality on the ground and to better align with corporate results indicators. The new definition is : 1) Assisted deliveries +Number of women aged 15-49 years who are continued users of long term methods of family planning + number of children under 2 years old who have 4 growth monitoring and promotion sessions in the year + children 9-11 months receiving measles and rubella vaccination. End target is cumulative number for the entire project. Current actual value includes available data as of September 2017. 1/27/2018 Page 8 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) PHINDPDOTBL  Female beneficiaries (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 99.90 86.14 80.00 Overall Comments In the absence of gender breakdown for MR vaccination and growth monitoring, these indicators are calculated under an assumption that 50% is female for these two indicators. Intermediate Results Indicators PHINDIRITBL  Number of new born children provided with birth notification in target provinces (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 40% over Value 93,586.00 20,224.00 93,586.00 baseline Date 31-Dec-2017 30-Jun-2017 31-Dec-2017 31-Dec-2020 Comments Baseline value has been updated to cover period January -December 2017 (12 months) based on the most recent data from DHIS2, given that earlier we could only obtain data for the period January-June 2017 (first 6 months of calendar year 2017), and this was the baseline in the PAD.The current actual value is therefore same as the revised baseline data. PHINDIRITBL  Children age 0-6 months in target high priority nutrition districts exclusively breastfed. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value TBD -- TBD TBD Date 01-Oct-2015 -- 31-Dec-2017 31-Dec-2020 Comments This was PDO level indicator under the original project but moved to intermediate outcome level during the September 2017 restructuring. 1/27/2018 Page 9 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) The Knowledge, Attitude and Practice (KAP) baseline survey has been completed but the final results are still unable to establish a credible baseline. This indicator will be updated in the next ISR when the final results become available. PHINDIRITBL  Percentage of data reports from the Target Provinces provided on time and fully completed in accordance with the National Guidelines for DHIS2 Implementation (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 54.10 83.00 86.00 90.00 Date 01-Oct-2015 31-May-2017 31-May-2017 31-Dec-2020 Comments Actual percentage is based on the most recent data from DHIS2 aligned with the DLI reporting period of June 2016 – May 2017. This indicator is reported based on yearly average of completeness and timeliness. Completeness is now 99% and timeliness 86%. As the portal allows entry of only one value, the ISR indicates the timeliness value (86%) in the main section. PHINDIRITBL  Number of immunization target districts that have increased their coverage of IPV (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 8.00 Date 30-Sep-2017 -- 31-Dec-2017 31-Dec-2020 Comments This is a new indicator recently introduced during the additional financing and restructuring of the project. The baseline coverage data for all districts in target provinces has been received on the due date of 30th September 2017, on which basis the 50 immunization target districts were selected. By the end of the project, this indicator requires each district to improve immunization coverage from its baseline value by 8 percentage points. The baseline and current year values are 0 districts since the indicator measures the number of districts that have increased the coverage and the first results are only due in end-2018. The end target is 8 districts who achieve this increase. 1/27/2018 Page 10 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) PHINDIRITBL  Number of health centers directly entering DHIS2 data (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 17.00 200.00 Date 31-May-2017 30-Aug-2017 31-Oct-2017 31-Dec-2020 Comments This is a new indicator introduced during the September 2017 restructuring. The current actual value represents the value as of October 2017 based on NPCO's annual report submitted on October 31 2017. PHINDIRITBL  Number of villages in Zones 2 and 3 in which complete Integrated Outreach Sessions are conducted at least three times during the year (DLI P5). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 468.00 639.00 800.00 Date 01-Oct-2015 31-May-2017 31-Oct-2017 31-Dec-2020 Comments Current actual value is based on the DLI report covering the period June 2016-May2017, based on the NPCO report submitted on October 31, 2017. The end target measures the number of villages that have completed three integrated outreach sessions during the year (12 month period) and is revised to be scalable. PHINDIRITBL  Number of women in Target Provinces who receive free maternity health care services (DLI C4). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Average of 14 provinces Value 47,066.00 202,789.00 203,154.00 increase by 20% over baseline Date 01-Oct-2015 31-May-2016 31-Oct-2017 31-Dec-2020 Comments Current actual value is aligned with the DLI reporting period covering June 2016 - May2017, based on the annual NPCO report submitted on October 31, 2017. The indicator includes 4th ANC, free delivery and PNC. End target has been revised during the September 2017 restructuring from 40% over baseline to 20% over baseline. 1/27/2018 Page 11 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) PHINDIRITBL  Percentage of health centers and district hospitals which score more than 50% on the Standard Supervisory Checklist monitored every six months of the Year (DLI P6). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 49.6% 49.6% 80% or more Date 01-Oct-2015 31-May-2017 31-Oct-2017 31-Dec-2020 Comments Current actual value is aligned with the DLI reporting period covering June 2016 - May2017, based on the annual NPCO report submitted on October 31, 2017. PHINDIRITBL  Social and Behavior Change Communication - Female village facilitators trained in SBCC in target districts (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 220.00 220.00 1,600.00 Date 01-Oct-2015 31-Jul-2017 31-Oct-2017 31-Dec-2020 Comments All female village facilitators have been trained for first year roll-out of 120 villages. The current actual value is as of November, based on the latest reporting but is expected to increase when reporting is completed. 1/27/2018 Page 12 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) PHINDIRITBL  Number of children under 2 years in target provinces who have at least 4 growth mointoring and promotion sessions in the year and their growth plotted in two specified growth charts (DLI P4). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 48,037.00 48,834.00 40,000 Date 31-Dec-2015 31-May-2016 31-Oct-2017 31-Dec-2020 Comments Current actual value is aligned with the DLI reporting period covering June 2016 - May2017, based on the annual NPCO report submitted on October 31, 2017, covering 4 nutrition target provinces only. This indicator has been revised during the September 2017 restructuring to be scalable to now include all 14 target provinces for next year. PHINDIRITBL  Social and Behavior Change Communication - Number of villages declared open defecation free in target districts. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value TBD 0.00 0.00 100.00 Date 01-Oct-2015 31-May-2017 31-Dec-2017 31-Dec-2020 Comments Actual value is based on the most recent NPCO reporting. The number of households with latrines did increase but none of the 120 villages that received community led total sanitation (CLTS) triggering had all households in their village with latrine and qualifying for declaring open defecation free village. The end target is formally revised during the September 2017 restructuring from 400 to 100. PHINDIRITBL  Number of immunization target districts which have increased their coverage of Pentavalent 3 (DPT-HebB-Hib) and Measles and Rubella (MR) immunization (DLI 8) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 25.00 Date 30-Sep-2017 -- 31-Oct-2017 31-Dec-2020 Comments This is a new indicator recently introduced during the additional financing and restructuring of the project. The baseline coverage data for all districts in target provinces has been received on the due date of 30th September 2017, on which basis the 50 immunization target districts were selected. By the end of the project, PDLI8 requires each district to improve immunization coverage from its baseline value by 8 1/27/2018 Page 13 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) percentage points. The baseline and current year values are 0 districts since the indicator measures the number of districts that have increased the coverage and the first results are only due in end-2018. Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P151425 IDA-56760 Effective USD 13.20 13.20 0.00 0.25 13.11 1.9% P151425 IDA-61450 Effective USD 10.00 10.00 0.00 0.00 10.36 0% P151425 IDA-D0730 Effective USD 13.20 13.20 0.00 11.86 1.06 92% P151425 TF-A6106 Effective USD 1.00 1.00 0.00 0.00 1.00 0% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P151425 IDA-56760 Effective 23-Jun-2015 17-Aug-2015 12-Oct-2015 31-Dec-2020 31-Dec-2020 P151425 IDA-61450 Effective 27-Sep-2017 06-Nov-2017 26-Dec-2017 31-Dec-2020 31-Dec-2020 P151425 IDA-D0730 Effective 23-Jun-2015 17-Aug-2015 12-Oct-2015 31-Dec-2020 31-Dec-2020 P151425 TF-A6106 Effective 27-Sep-2017 06-Nov-2017 26-Dec-2017 31-Dec-2020 31-Dec-2020 Cumulative Disbursements 1/27/2018 Page 14 of 15 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Lao PDR Health Governance and Nutrition Development Project (P151425) Restructuring History Level 2 Approved on 14-Aug-2015 Related Project(s) P163949-Additional Financing to Lao PDR Health Governance and Nutrition Development Project 1/27/2018 Page 15 of 15 Public Disclosure Copy