Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) DJ Improving Health Sector Performance (P131194) MIDDLE EAST AND NORTH AFRICA | Djibouti | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2013 | Seq No: 14 | ARCHIVED on 03-Dec-2019 | ISR38712 | Implementing Agencies: Republic of Djibouti, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 02-Apr-2013 Effectiveness Date: 11-Jul-2013 Planned Mid Term Review Date: 15-Mar-2016 Actual Mid-Term Review Date: 23-May-2016 Original Closing Date: 31-Dec-2018 Revised Closing Date: 31-Dec-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is to improve the utilization of quality health care services for maternal and child healthandcommunicable disease control programs (HIV/AIDS, tuberculosis and malaria). 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)HRPDODELs The project development objective is to improve the utilization of quality maternal and child health services. Components Table Name Improving health services delivery performance:(Cost $12.77 M) Strengthening health system management:(Cost $1.54 M) Strengthening program management and monitoring and evaluation capacity:(Cost $5.69 M) Contingent Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions 12/3/2019 Page 1 of 6 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) The project is on track to achieve the project development objective. To date, the project has supported over 86,000 pregnant women with completing 2 or more antenatal visits, and the quality of the health facilities has been improving. For some intermediate results indicators, the target has been surpassed. Over 99% of the funds under the parent project and the first additional financing has been disbursed. The second additional financing including project restructuring was approved on May 3, 2019 and is expected to become effective in November 2019. The restructuring included an extension of the project closing date, a revision of the results framework and the introduction of some additional activities and a contingent emergency response component, which enables quick disbursement of remaining funds if a health-related emergency/crisis occurs. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- Low Low Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Substantial Substantial Fiduciary -- Moderate Moderate Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- Moderate Moderate Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes To improve the utilization of maternal and child health services IN00748535 ►Number of women completing 2 or more prenatal visits (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 6,100.00 69,494.00 86,272.00 95,700.00 Date 01-Jun-2014 30-Jun-2018 30-Jun-2019 31-Dec-2020 IN00748637 ►Percentage of children fully immunized before their first birthday (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.00 78.58 78.58 85.00 12/3/2019 Page 2 of 6 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) Date 01-Dec-2012 31-Dec-2017 31-Dec-2017 31-Dec-2020 Instead of limiting the data to the facilities supported by the project, it was agreed that the national data should be reported. This is because many children are vaccinated at other facilities. 2018 data are being Comments: finalized. Quality health care services IN00748636 ►Average facility quality (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 29.00 46.00 59.00 65.00 Date 01-Dec-2012 31-Dec-2017 30-Apr-2018 31-Dec-2020 Intermediate Results Indicators by Components Improving health services delivery performance IN00748638 ►Number of WCBA visiting the public system to obtain modern family planning (oral contraceptives and injections) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7,304.00 92,504.00 104,742.00 130,000.00 Date 01-Nov-2014 30-Jun-2018 30-Jun-2019 31-Dec-2020 IN00748643 ►People receiving tuberculosis treatment in accordance with the WHO-recommended “Directly Observed Treatment Strategy” (DOTS) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 300.00 2,411.00 3,708.00 2,800.00 Date 01-Dec-2012 30-Jun-2018 30-Jun-2019 31-Dec-2020 IN00748644 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 190,385.00 271,438.00 250,525.00 Date 01-Nov-2014 30-Jun-2018 30-Jun-2019 31-Dec-2020 The target will be adjusted in the upcoming restructuring. Comments: IN00748645 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 0.00 86,438.00 155,600.00 143,025.00 IN00748646 12/3/2019 Page 3 of 6 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 28,469.00 36,980.00 45,000.00 Date 01-Nov-2014 31-Dec-2017 30-Jun-2019 31-Dec-2020 IN00748647 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 96,362.00 194,695.00 170,000.00 Date 01-Nov-2014 30-Jun-2018 30-Jun-2019 31-Dec-2020 IN00748648 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 24,023.00 39,763.00 35,525.00 Date 01-Nov-2014 31-Dec-2017 30-Jun-2019 31-Dec-2020 IN00748649 ►Number of HIV positive pregnant women receiving treatment according to protocol (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 63.00 300.00 397.00 400.00 Date 01-Nov-2014 02-Apr-2019 30-Jun-2019 31-Dec-2020 IN00748650 ►Number of displaced persons (refugees, asylum seekers and migrants) receiving services at health facilities (Number (Thousand), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 35,734.00 Date 31-Dec-2018 02-Apr-2019 30-Sep-2019 31-Dec-2020 Data will be collected once the AF2 becomes effective. Comments: IN00748651 ►Percentage of pregnant women receiving at least two doses of tetanus toxoid (TT2) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 90.00 90.48 55.00 Date 01-Dec-2012 31-Dec-2017 31-Dec-2017 31-Dec-2020 More up to date data became available for 2017. 2018 data are being finalized. Comments: Strengthening health system management IN00748639 ►Community survey conducted and results shared with contracted facilities (Yes/No, Custom) 12/3/2019 Page 4 of 6 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 31-Dec-2018 31-Dec-2018 30-Jun-2019 31-Dec-2020 IN00748641 ►Number of health care providers trained on DHIS2 (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 312.00 Date 31-Dec-2018 31-Dec-2018 30-Jun-2019 31-Dec-2020 Strengthening project management and monitoring and evaluation capacity IN00748640 ►Number of new curative care visits per person per year in the public system (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.15 0.47 0.54 0.65 Date 01-Nov-2014 31-Dec-2017 30-Jun-2019 31-Dec-2020 IN00748642 ►Percentage of beneficiaries satisfied with health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 60.00 Date 31-Dec-2018 31-Dec-2018 30-Jun-2019 31-Dec-2020 Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P131194 IDA-52160 Effective USD 7.00 7.00 0.00 6.55 0.00 100% Not P131194 IDA-64080 USD 1.00 1.00 0.00 0.00 1.10 0% Effective Not P131194 IDA-D4590 USD 5.00 5.00 0.00 0.00 4.95 0% Effective P131194 TF-19258 Effective USD 7.00 7.00 0.00 6.91 0.09 99% Key Dates (by loan) 12/3/2019 Page 5 of 6 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P131194 IDA-52160 Effective 02-Apr-2013 21-Apr-2013 11-Jul-2013 31-Dec-2018 31-Dec-2020 Not P131194 IDA-64080 03-May-2019 03-Jul-2019 -- 31-Dec-2020 31-Dec-2020 Effective Not P131194 IDA-D4590 03-May-2019 03-Jul-2019 -- 31-Dec-2020 31-Dec-2020 Effective P131194 TF-19258 Effective 13-May-2015 13-May-2015 27-Jul-2015 31-Dec-2018 31-Dec-2020 Cumulative Disbursements Restructuring History Level 1 Approved on 23-Apr-2015 ,Level 2 Approved on 17-Dec-2018 Related Project(s) P152705-DJ HRITF Health AF ,P168250-Improving Health Sector Performance Project Second Additional Financing 12/3/2019 Page 6 of 6