The World Bank Report No: ISR16220 Implementation Status & Results Kyrgyz Republic Health & Social Protection Project (P084977) Public Disclosure Copy Operation Name: Health & Social Protection Project (P084977) Project Stage: Implementation Seq.No: 13 Status: ARCHIVED Archive Date: 29-Sep-2014 Country: Kyrgyz Republic Approval FY: 2006 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of Health Key Dates Board Approval Date 15-Dec-2005 Original Closing Date 30-Jun-2011 Planned Mid Term Review Date Last Archived ISR Date 06-Mar-2014 Effectiveness Date 08-Jun-2006 Revised Closing Date 30-Jun-2015 Actual Mid Term Review Date 28-May-2008 Project Development Objectives Project Development Objective (from Project Appraisal Document) The original project development objectives were amended to include two additional specific objectives (objectives [d] and [e] below) under the proposed additional financing. The revised objectives are to improve health status in the Kyrgyz Republic: (a) by improving access, financial protection, efficiency, equity and fiduciary performance in the Kyrgyz health sector; (b) to ensure sufficient and reliable financing for the health sector; (c) to strengthen the targeting of social benefits by developing effective administration and information management systems to improve access to social services in general; (d) protecting and improving health and nutritional status of particularly vulnerable populations in the Kyrgyz Republic in the face of food price shocks, by providing nutritional supplements and nutrition education to pregnant/lactating women and infants/young children; and (e) helping poor Kyrgyz families manage and mitigate the impact of food price shocks and protect consumption (general and food consumption) by scaling up and strengthening targeted cash transfers. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Component 1: Support for the Manas Taalimi Health Reform Program and its associated Program of 34.10 Work Public Disclosure Copy Component 2: Strengthening the Administrative System of the Ministry of Labor and Social Protection 7.30 Component 3: Protecting Health and Nutritional Status 3.60 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating High High Page 1 of 7 The World Bank Report No: ISR16220 Implementation Status Overview On the health sector: Activities planned and agreed under the 2014 Annual Program of Work are well underway. As such, it is expected that all activities will be completed by the closing date of June 30, 2015. Progress towards achievement the Project Development Objectives will be assessed as part of a technical assistance that will take place in mid- October 2014 to review and consolidate the SWAp Results Framework for the Project and the Joint Assessment Framework for the Den Sooluk. Recommendations will provide the Public Disclosure Copy ground for necessary modifications of the RF for SWAp2 (now effective) and JAF as may be appropriate. On the Social Protection sector: The Ministry of Social Development (MoSD) continues implementing agreed measures to fully operationalize the social assistance beneficiary registry. A technical assistance on Business Processes, undertook several missions in the first half of 2014 and provided support to the MoSD in planning a set of activities to reach this objective, which has been discussed with the IT Department and made a number of suggestions building on it. This includes hiring two short-term consultants to support the process and preparing a time-bound and sequenced plan. All activities planned under the SP component are expected to be completed by the closing date. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Health statistics show improvements on overall Text Value Annual health statistics IMR reduced from 21.1 to 20; Greater progress health status U5MR from 38 to 37; MMR from 50.3 to 38; CVD mortality from 17% (2011) to 15% (2012); TB mortality from 8.7% (2011) to 8.1% (2012) Date 11-May-2004 08-Sep-2014 30-Jun-2015 Comments On track. Per 10,000 (JAR, 2013) Maintain or increase total spending on the Text Value 18.5% Sustain UMB as a share of the poverty gap Date 30-Dec-2006 08-Sep-2014 30-Jun-2014 Comments Household Budget Survey; Spending on former UMB Public Disclosure Copy (current Monthly Benefit Package for Poor Family, MBPF) has increased from KGS 2.01bn in 2013 to KGS 2.8 bn in 2014 Page 2 of 7 The World Bank Report No: ISR16220 Nutritional status measured as a percentage of Text Value n/a Not yet available >60% anemic children age 6-24 by nutritional >75% supplement and children under 5 with VitaminA Date 14-Dec-2004 08-Sep-2014 30-Jun-2015 Public Disclosure Copy Comments Revised with AF2 Nationwide data: 82.8% of children 6-24 months received sprinkles. Decreased percent of anemic pregnant women Text Value 40% 37.8% 20% Date 11-May-2011 08-Sep-2014 30-Jun-2015 Comments New PDO indicator with AF2 DHS 2012 data. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percent of adults and children with HIV Percentage Value 42.50 57.60 100.00 receiving antiretroviral combination therapy Date 28-May-2008 08-Sep-2014 30-Jun-2015 Comments Original indicator continued Data from previous ISR with AF2; there were no calculated the indicator on the baseline in 2004; baseline basis of 945 adults/children from MTR instead of 3000 new cases that were identified in 2011; TA to reconcile JAF/SWAp RF planned in mid-October will confirm data. Increased percentage of pregnant women Percentage Value 28.50 92.00 100.00 living with HIV who received antiretroviral Date 28-May-2008 31-Jan-2014 30-Jun-2015 (ARV) to reduce the risk of MTCT Comments Original indicator continued On track. with AF2; there were no baseline in 2004; baseline from MTR Improved fiduciary performance in measured Text Value n/a Unqualified audit for FY13 Financial audit in time of good by timely submission of financial statements received and FMRs received quality; FMRs timely Public Disclosure Copy and audits submitted and of good quality Date 14-Dec-2004 08-Sep-2014 30-Jun-2015 Comments Revised with AF2 (more Achieved. specific and measurable indicator) Page 3 of 7 The World Bank Report No: ISR16220 Decreased percent of out-of-pocket health Text Value 7.1/5.5 percent 4.8/2.9 4.0/4.0 percent expenditures as a share of total household Date 14-Dec-2004 08-Sep-2014 30-Jun-2015 consumptionin two poorest quintiles Comments Original indicator revised with Public Disclosure Copy AF2 (clarified and target value added) Government spending on non-salary recurrent Text Value 1.26% 0.96 Sustain costs as a percentage of GDP Date 11-May-2011 08-Sep-2014 30-Jun-2015 Comments Revised with AF2. 2011 data Decreased from 1.26 in 2011 to 0.96 in 2012 due to salary increase of 2011, this indicators is not sustained from baseline data Percent of population not seeking care when Text Value 3.1% 4.4% needed due to geographic and financial Date 31-Dec-2006 08-Sep-2014 30-Jun-2015 reasons Comments 2006 data. New indicator with 2009 data. No target AF2 Immunization coverage by age 2+ with basic Text Value 95.0% 96.5 >97% vaccines Date 11-May-2011 08-Sep-2014 30-Jun-2015 Comments Pilot community based mental health to Text Value Initiated TORs developed and cleared Piloted contribute to strengthening social cohesion by the Bank Date 11-May-2011 08-Sep-2014 30-Jun-2015 Comments New indicator with AF2 Implementation ongoing Establish unified perinatal Center for all Text Value n/a Master plan finalized Completed communities in the 3 south oblasts to increase Date 11-May-2011 08-Sep-2014 30-Jun-2015 efficiency and social reconcilation Comments New indicator with AF2 Architectural design launched. Construction to be financed under SWAp2; activity had an unrealistic timeline under AF2 Public Disclosure Copy timeframe given complexity of the task and one-year delay of Project effectiveness from approval Maintain or increase in total coverage of the Text Value 352,146 322,028 Sustained UMB program Date 01-Dec-2011 08-Sep-2014 30-Jun-2015 Comments Indicator was revised with Off track. Number of AF2 and moved from PDO to beneficiaries has declined Intermediate indicators due to the lowering of the age of eligibility from 23 to 16 and Page 4 of 7 The World Bank Report No: ISR16220 measures to counterfraud and corruption. Automated management information system Text Value No Noted progress Improved (national beneficiary database) designed, Public Disclosure Copy Date 14-Dec-2004 08-Sep-2014 30-Jun-2015 effectively implemented, and providing timely Comments Original indicator continued On track. Progress made in andaccurate data to analyze, design and monitor social policy with AF2 implementation of the Registry (MIS). Further actions identified to make it fully operational by end of CY 2014. Reduced turn-around time for registering Text Value n/a Noted progress 5 days families for potential eligibility under the UMB Date 14-Dec-2004 08-Sep-2014 30-Jun-2015 program Comments Original indicator continued On track. Full roll out of with AF2, but target value Registry will make attainment added of indicator target possible by end of CY 2014. Percentage of children under 5 receiving a Text Value n/a Vitamin A included in 80% dose of Vitamin A Sprinkles (see related PDO indicator) Date 08-Sep-2014 30-Jun-2015 Comments Original indicator continued Low level of Vitamin A with AF2 deficiency at 4.2 in 2009 (survey) Percent of anemic pregnant women who are Text Value n/a 85% 80% prescribed and receive iron-containing tablets Date 11-May-2011 08-Sep-2014 30-Jun-2015 Comments New indicator with AF2 to Achieved. 2012 data. measure new activities Health personnel receiving training (number) Number Value 0.00 1060.00 Date 14-Dec-2004 08-Sep-2014 30-Jun-2015 Comments Original indicator continued Cumulative. Training on no target Public Disclosure Copy with AF2. It is core indicator. fiduciary issues (FM and procurement). Health facilities constructed, renovated, and/or Number Value 0.00 0.00 0.00 equipped (number) Date 14-Dec-2004 08-Sep-2014 30-Jun-2015 Comments Original indicator continued Data is for # of facilities no target with AF2 equipped only; large tenders for procurement of medical equipment ongoing. Data on Financial Performance (as of 19-Aug-2014) Page 5 of 7 The World Bank Report No: ISR16220 Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P084977 IDA-49570 Effective 09-Jun-2011 22-Nov-2011 28-Aug-2012 30-Jun-2014 30-Jun-2015 Public Disclosure Copy P084977 IDA-H1970 Closed 15-Dec-2005 10-Mar-2006 08-Jun-2006 30-Jun-2011 30-Jun-2013 P084977 IDA-H3910 Closed 12-Jun-2008 25-Jun-2008 31-Jul-2008 30-Jun-2011 31-Dec-2011 P084977 IDA-H7000 Effective 09-Jun-2011 22-Nov-2011 28-Aug-2012 30-Jun-2014 30-Jun-2015 P084977 TF-11265 Closed 25-Jan-2012 26-Mar-2012 26-Mar-2012 31-Mar-2012 31-Mar-2012 P084977 TF-11531 Closed 30-Jan-2012 26-Mar-2012 26-Mar-2012 30-Jun-2012 30-Jun-2012 P084977 TF-56540 Closed 08-Jun-2006 08-Jun-2006 08-Jun-2006 28-Feb-2011 28-Feb-2011 P084977 TF-56799 Closed 14-Nov-2006 14-Nov-2006 14-Nov-2006 28-Feb-2011 28-Feb-2011 P084977 TF-90119 Closed 18-Aug-2007 18-Aug-2007 18-Aug-2007 28-Feb-2011 28-Feb-2011 P084977 TF-91613 Closed 04-Jul-2008 04-Jul-2008 04-Jul-2008 31-Jan-2011 31-Jan-2011 P084977 TF-97870 Closed 29-Mar-2011 06-Jun-2011 06-Jun-2011 30-Jun-2011 30-Jun-2011 P084977 TF-98740 Closed 28-Mar-2011 06-Jun-2011 06-Jun-2011 30-Jun-2011 30-Jun-2011 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P084977 IDA-49570 Effective USD 13.20 13.20 0.00 9.75 3.10 74.00 P084977 IDA-H1970 Closed USD 15.00 15.00 0.00 16.02 0.00 107.00 P084977 IDA-H3910 Closed USD 6.00 6.00 0.00 5.71 0.00 95.00 P084977 IDA-H7000 Effective USD 10.80 10.80 0.00 10.51 0.00 97.00 P084977 TF-11265 Closed USD 3.07 3.07 0.00 3.03 0.00 99.00 P084977 TF-11531 Closed USD 1.12 1.12 0.00 1.12 0.00 100.00 P084977 TF-56540 Closed USD 11.36 11.35 0.01 12.05 0.00 106.00 P084977 TF-56799 Closed USD 3.00 3.00 0.00 3.00 0.00 100.00 P084977 TF-90119 Closed USD 14.31 14.31 0.00 12.25 0.00 86.00 P084977 TF-91613 Closed USD 3.72 3.72 0.00 3.72 0.00 100.00 Public Disclosure Copy P084977 TF-97870 Closed USD 1.12 1.12 0.00 1.12 0.00 100.00 P084977 TF-98740 Closed USD 1.43 1.43 0.00 1.50 0.00 105.00 Disbursement Graph Page 6 of 7 The World Bank Report No: ISR16220 Public Disclosure Copy Key Decisions Regarding Implementation N/A Restructuring History There has been no restructuring to date., Level two Approved on 31-May-2011, Level two Approved on 23-Sep-2011, Level 2 CD Decision on 12-Mar-2014 Related Projects P112142-Health & Social Protection Project, P125470-Additional Financing 2 Kyrgyz Health and Social Protection Public Disclosure Copy Page 7 of 7