The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) REPORT NO.: RES47699 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF TAJIKISTAN HEALTH SERVICES IMPROVEMENT PROJECT (HSIP) APPROVED ON JULY 30, 2013 TO REPUBLIC OF TAJIKISTAN HEALTH, NUTRITION & POPULATION EUROPE AND CENTRAL ASIA Regional Vice President: Anna M. Bjerde Country Director: Tatiana A. Proskuryakova Regional Director: Fadia M. Saadah Practice Manager/Manager: Tania Dmytraczenko Task Team Leader(s): Mirja Channa Sjoblom, Baktybek Zhumadil The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) ABBREVIATIONS AND ACRONYMS AF1 First Additional Financing AF2 Second Additional Financing CPF Country Partnership Framework CQI Collaborative Quality Improvement CSCs Citizen scorecards DHS Demographic and Health Survey Gavi The GAVI Alliance GoT Government of Tajikistan HH Health houses HNP Health, Nutrition, and Population HRITF Health Results Innovation Trust Fund HSIP Health Services Improvement Project ICR Implementation Completion and Results Report IDA International Development Association IR Intermediate Results MIS Management Informational System MOHSP Ministry of Health and Social Protection MOF Ministry of Finance NDS National Development Strategy PBF Performance-Based Financing PCF Per capita financing PDO Project Development Objective PHC Primary health care RHCs Rural health centers TF Trust Fund TSG Technical Support Group The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) BASIC DATA Product Information Project ID Financing Instrument P126130 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 30-Jul-2013 30-Jun-2022 Organizations Borrower Responsible Agency Ministry of Health & Social Protection Project Republic of Tajikistan Coordination Group,Ministry of Health & Social Protection Project Development Objective (PDO) Original PDO The Project Development Objective (PDO) is to contribute to the improvement of the coverage and quality of basic primary health care (PHC) services in rural health facilities in selected districts. Current PDO The revised PDO is to contribute to the improvement of the coverage and quality of basic primary health care (PHC) services in selected districts. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-D5470 18-Dec-2019 16-Nov-2020 09-Feb-2021 30-Jun-2022 10.00 3.06 7.32 IDA-56660 22-Jun-2015 07-Aug-2015 04-Dec-2015 31-Dec-2019 5.50 5.57 0 IDA-D0700 22-Jun-2015 07-Aug-2015 04-Dec-2015 30-Sep-2020 4.50 4.63 0 IDA-H8790 30-Jul-2013 20-Sep-2013 11-Dec-2013 31-Dec-2019 15.00 14.09 0 The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) TF-B2817 16-Nov-2020 16-Nov-2020 09-Feb-2021 31-Dec-2021 2.00 1.33 .67 TF-14871 20-Sep-2013 20-Sep-2013 11-Dec-2013 31-Dec-2019 4.80 4.80 0 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING 1. The SDR 10 million (US$15 million equivalent) project, with US$ 4.8 million in co-financing from the Health Results Innovation Trust Fund (HRITF), was approved by the Board on July 30, 2013 and declared effective on December 11, 2013 with an original closing date of January 31, 2019. The project has had two additional financings (AFs) and has been restructured three times. The first AF (AF1), for SDR 7.3 million (US$10 million equivalent), was approved on June 22, 2015 and financed costs associated with: (i) the financing gap arising from construction of rural health centers (RHCs); and (ii) the scaling-up of activities initiated under the original IDA grant to cover additional primary health care facilities in four districts. The first restructuring, processed concurrently with the AF1, included: (i) a minor revision of the Project Development Objective (PDO); (ii) adjustments to the project results framework; and (iii) an 11-month extension of the closing date of the original IDA Grant No. H8790-TJ, from January 31, 2019 to December 31, 2019. A second restructuring (August 2018) extended the closing date of the HRITF co-financing grant in a similar manner, from January 31, 2019 to December 31, 2019. The third restructuring (September 2019) extended the closing date of the AF1 IDA Grant No. D070-TJ by another nine months, from December 31, 2019 to September 30, 2020, to avoid a gap between the closure of the AF1 and effectiveness of the second AF (AF2) that was under preparation.1 AF2, for SDR 7.3 million (US$10 million equivalent IDA grant co-financed by a US$2 million recipient-executed Gavi grant) was approved on December 18, 2019 and is supporting the Government’s efforts to address persistent challenges in PHC, including by institutionalizing the performance-based financing (PBF) scheme piloted under the Project. Despite best efforts, there was a 1.5-month gap between the closure of AF1 and the signing of AF2, with effectiveness of AF2 declared only in February 2021, representing a 13-month delay in effectiveness, which has significantly shortened the AF2 implementation period. Project Implementation Status 2. Progress towards achievement of the PDO. The revised PDO2 is to contribute to the improvement of the coverage and quality of basic primary health care (PHC) services in selected districts. Progress towards achievement of the PDO is rated Moderately Satisfactory given the positive progress on several technical activities and procurement processes that are contributing to the achievement of the PDO. However, prior to May 2021, both PDO and IP were rated Moderately Unsatisfactory, largely due to the delay in the signing and effectiveness of the AF2, that caused implementation delays. As such, technical activities only started in February 2021, after which 1The other three sources of financing—IDA Grant No. H8790-TJ, HRITF Grant No. TF014871, and IDA Credit No. 5666-TJ—closed on December 31, 2019. 2 Revised as part of the restructuring associated with AF1 (per the preceding paragraph). The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) implementation has intensified. To-date, one of the three PDO indicators has been achieved (mothers receiving timely postnatal counseling), one PDO indicator has almost been achieved (average health facility quality of care score), and the third PDO indicator has been impacted by the COVID-19 pandemic and the gap between the AF1 closure and AF2 effectiveness but is on track to be achieved with the extension (mothers counseled on nutrition). Of the 11 intermediate results indicators, five have been achieved, three are on track to be achieved by the current Project closing date, and three remain achievable with the proposed extension. 3. Implementation status. Overall implementation progress is rated Moderately Satisfactory. The Performance- based financing scheme (PBF; Component 1) has been launched in all 16 project-supported districts. Efforts to improve quality of care (Component 2) are also advancing, including several types of training: the first round of a 6-month family medicine training program was completed with 147 graduates, and an 11-month training program in PHC management, short-term training courses for heads of RHCs, and a 2-year post-graduate training program in family medicine are all ongoing and progressing as planned. With regards to strengthening physical infrastructure, a site survey of facilities in the new districts has been conducted, facilities in need of rehabilitation work have been identified, and the rehabilitation works are starting over the next months. Procurement processes of medical equipment and office equipment have been launched and computers have already been delivered to PHC facilities. Despite progress achieved so far in project implementation, there is not enough time to complete all activities under the three Components, with the current closing date as some interventions cannot be fast-tracked to accommodate the shortened implementation period resulting from delays in effectiveness. However, with an extension of the closing date by 12 months, it is expected that the remaining activities will be completed. 4. Commitments and disbursements. As of December 13, 2021, US$ 33.47 million (80.73 percent) has been disbursed.3 Commitments amount to an additional US$ 6.21 million (14.86 percent). Pending approval of the restructuring, an additional US$ 3.5 million in disbursements (IDA and Gavi) are expected in FY22. Continued relevance of the Project 5. The Project continues to be highly relevant and fully aligned with the “National Development Strategy of the Republic of Tajikistan for the period of 2030” (NDS 2030), the recently adopted “Strategy on Healthcare of Population of the Republic of Tajikistan up to 2030” (NHS 2030), as well as other national and sector-specific strategic and planning documents. The PDO is in line with the NDS 2030 priority on development of human capital, which calls for an effective and efficient healthcare system, where a strong and well-functioning primary health care system is essential. The Project contributes to and will support the NHS 2030’s overall goal to provide every citizen of Tajikistan with accessible and quality healthcare through effective governance, sustainable financing, workforce provision and development of information technologies. 6. The Project is closely aligned with the 2018 Tajikistan Systematic Country Diagnostic and the Country Partnership Framework (CPF) for FY2019-23. AF2 is included in the CPF (135875-TJ) and is consistent with the objectives of Pillar 1 (Human Capital and Resilience) of improving nutrition, hygiene, and reducing the under-five mortality 3Disbursements account for exchange rate fluctuations between SDR and USD and are as follows, by financing source: (i) IDA-H8790: US$ 14.09 million equivalent disbursed (100 percent); (ii) IDA-D0700: US$ 4.63 million equivalent disbursed (100 percent); (iii) IDA- 56660: US$ 5.57 million equivalent disbursed (100 percent); (iv) TF-14871: US$ 4.8 million disbursed (100 percent); (v) IDA-D5470: US$ 3.06 million equivalent disbursed (30.6 percent); and (vi) TF-B2817: US$ 1.33 million disbursed (66.66 percent). The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) rate, which is still high. It directly contributes to the second objective of the CPF, Enhancing Health Services, and two of the CPF’s indicators under this objective: (i) percentage of children aged 12–24 months in project districts who receive all basic vaccinations; and (ii) children under five years in project districts with height and weight measured in previous six months. In the context of the COVID-19 pandemic, the Project’s relevance has increased as many COVID-19 cases have been managed through home-based care, provided by PHC facilities. Furthermore, the project helps ensure access to quality basic health services at the primary health care level and contributes to strengthening primary health care, also essential for the national COVID-19 response, including the COVID-19 vaccination program. Rationale for restructuring 7. The Government of Tajikistan (GoT), through the letter # 5/5-19/615 from the Ministry of Finance (MOF) dated July 7, 2021, requested a 12-month extension of the closing date and a reallocation of the funds among withdrawal categories to rebalance financing for the AF2 grant. More specifically, the MOF requested to (i) adjust downward the amount of financing allocated to PBF scheme in line with actual needs of the streamlined version of the scheme; and (ii) increase the share of Project proceeds allocated to rehabilitation of rural health facilities and supervision of rural health centers. 8. Given the delays in project implementation caused by the 13-month delay in effectiveness of AF2, there is a need to extend the closing date to provide the necessary time to complete activities that were technically designed to be implemented within 30 months. For the same reasons, a twelve-month extension of the closing date of grant TF0B2817,4 from December 31, 2021 to December 31, 2022, is also needed and has been approved by Gavi, the donor of this Trust Fund. The Project extension will also allow for smooth transition of activities to the new health project that is currently under preparation with expected delivery in FY2023. The following activities were planned under AF2 and will be completed during the extension: (a) minor repair works and provision of essential medical equipment in 38 PHC facilities; (b) completion of all trainings activities; (c) completion of household/community engagement activities; and (d) institutionalization of the PBF scheme. 9. To make the PBF scheme more sustainable, the Project has been supporting a streamlined PBF scheme for PHC services with smaller incentive payments. The streamlined PBF scheme includes fewer indicators (seven in total) that generate quantity payments and is being implemented in all 16 project districts. Incentive payments associated with each of these seven indicators have been reduced to more sustainable levels in the streamlined scheme to pave the way for strategic purchasing of PHC with future government funding. Because of the drop in the number of indicators that generate payments, as well as the lower amount of payment per indicator, optimistic projections based on the first round of verification data with the new streamlined PBF program show that the total amount allocated to this category in the budget will not be disbursed by June 30, 2022, even if it is assumed that all facilities achieve all performance targets. Thus, the estimated amount for this category was overestimated in the original budget and there is a total estimated amount of US$550,000 in savings in Component 1: PBF (Category 1). 10. These savings will be used for Component 1: PBF (Category 2) and Subcomponent 2.2: Physical Infrastructure Improvement (Category 3). Regarding reallocation to Component 1 PBF (Category 2), there is a need to strengthen supervision of PBF facilities by District Health Teams in the six districts where the PBF was recently launched. Quarterly supervision visits are critical for the functioning of the PBF scheme to support PHC providers in 4 Funded from the Integrating Donor Funded Health Programs Multi-Donor Trust Fund The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) achieving performance results, carry out supervision controls, and approve action plans prepared by RHCs/HHs, as per the PBF Manual. Some supervision vehicles were provided in the 10 districts (for 20 out of 37 newly constructed RHCs) supported by the Project, but vehicles were omitted in the budget for six districts that are implementing PBF, and therefore supervision visits have not taken place in these six districts. The reallocation from PBF payments (Category 1) will be used to procure vehicles to strengthen supervision in the six districts, with the aim to improve RHCs/HHs performance under the PBF scheme. All other costs for supervision, including fuel, staff etc., are already accounted for in the government budget. Regarding the reallocation to Subcomponent 2.2: Physical Infrastructure Improvement (Category 3), the Ministry of Health and Social Protection (MoHSP) Department of Capital Construction, with support from technical experts in the MoHSP Technical Support Group (TSG), has surveyed RHCs supported by the Project that participate in the PBF scheme. The survey shows that the estimated cost for repairing the RHCs that meet the criteria for selection for rehabilitation works, was substantially higher than the estimated cost ($5,000-$7,000) that the original budget was based on. Thus, the estimated budget for this sub-component was underestimated. Given this, a cost ceiling of US$30,000 per facility has been set and an estimated 40 facilities have been selected for rehabilitation works. To meet the PDO, and to ensure that primary care facilities are appropriately supervised in the six PBF districts and provided with minor rehabilitation to ensure basic functionality, vaccine effectiveness and capacity to fulfill PBF requirements, it is critical to reallocate between disbursement categories. Financing will increase for Component 1 PBF (Category 2) and Subcomponent 2.2 Physical Infrastructure Improvement (Category 3) with the savings under Component 1 PBF (Category 1). II. DESCRIPTION OF PROPOSED CHANGES 11. This restructuring seeks to: (i) extend the closing date of the project; (ii) reallocate between disbursement categories; (iii) change the components and costs; (iv) adjust the implementation schedule; (v) update disbursement estimates; and (vi) revise the results framework to align it with the revised closing date. The proposed changes will facilitate full achievement of the PDO and adjust existing activities to improve the sustainability of outcomes. 12. Closing Date. To compensate for the delays incurred at the signing and effectiveness stages of AF2 and provide the necessary time for completion of all activities needed to achieve the PDO, a twelve-month closing date extension of the IDA Grant No. D547-TJ, from June 30, 2022 to June 30, 2023, and a twelve-month Closing Date extension of the Grant No. TF0B2817 funded from the Integrating Donor Funded Health Programs Multi-Donor Trust Fund, from December 31, 2021 to December 31, 2022, are proposed. This would be the third extension of the closing date, which would result in the total project duration of 9 years and 11 months. 13. Reallocation between disbursement categories. This restructuring will reallocate SDR 393,279 (US$550,000 equivalent) of IDA Grant (No. D547-TJ from Component 1 PBF (Category 1) to Component 1 PBF (Category 2) and to Subcomponent 2.2 Physical Infrastructure Improvement (Category 3), as outlined in Table 1 below. Allocation of the Gavi co-financing (TF0B2817) remains unchanged. Table 1: Original and Revised Allocations by Disbursement Categories for IDA Grant (D547-TJ Original Amount of Revised Amount of Change in Category the Financing the Financing Allocation Allocated (SDR) Allocated (SDR) (1) PBF Scheme under Component 1 (a) of the Project 1,700,000 1,306,721 (393,279) The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) (2) Goods, works (other than for Component 2.2 (iii) of the Project, non-consulting services, consulting services, 5,000,000 5,117,269 117,269 PBF Scheme Costs under Component 1 (b) of the Project, Training and Incremental Operating Costs (3) Works under Component 2.2 (iii) of the Project 600,000 876,010 276,010 Total amount 7,300,000 7,300,000 - Note: The US$2 million of Gavi co-financing is not reallocated between disbursement categories and therefore not included in the table. 14. Changes to the components and costs: Some additional adjustments will also be made to the costs of activities under Component 1 PBF and Component 2 Primary Health Care Strengthening (within Category 2) through updates to the procurement plan. These proposed reallocations will not affect the allocations under the Gavi co- financing amount and will enable full utilization of the total financing. Detailed information on components and costs is outlined in Table 2. Table 2: Changes to Components and Costs for IDA Grant (IDA D5470) and Gavi Grant (TF0B2817) Original Financing (USD) Revised Financing (USD) Change in Component Name IDA Gavi IDA Gavi Allocation Component 1. Performance- (386,000) Based Financing 4,370,000 1,505,000 3,984,000 1,505,000 Component 2. Primary Health 386,000 Care Strengthening 3,680,000 495,000 4,066,000 495,000 Component 3. Project 0 Management, Coordination, and Monitoring & Evaluation 1,950,000 0 1,950,000 0 Total amount 10,000,000 2,000,000 10,000,000 2,000,000 Note: The US$2 million of Gavi co-financing is not reallocated between project components. 15. Implementation Schedule. The implementation schedule has been revised to be consistent with the proposed twelve-month closing date extension of the IDA Grant D-547-TJ. 16. Disbursement estimates. Disbursement estimates and timeframe have been revised to update projections based on the proposed closing date extension and expected implementation pace of the ongoing and remaining activities. 17. Results Framework. Only minor changes proposed to be made to the Results Framework, consisting of adjustments to intermediate and end-target dates of most PDO-level and Intermediate Result indicators with both types of adjustments aimed at aligning the Results Framework with the proposed closing date extension. 18. Social and Environmental Safeguards. The proposed restructuring does not change the project’s environmental and social risk classification and it does not trigger the application of any new policies or exceptions to any Bank safeguard policies. Physical works to be supported by the project are limited to installation of solar panels/heaters at RHCs within the existing footprint of these facilities and minor rehabilitation of selected primary care facilities in new project districts. 19. Financial Management and Procurement arrangements. There will be no changes in Financial Management and Procurement arrangements. Financial Management arrangements, including accounting and reporting arrangements, internal control procedures, planning and budgeting, external audits, funds flow, organization and staffing arrangements will remain as specified in the original project design. Financial Management performance The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) assessed as satisfactory and there are no overdue audits or interim (unaudited) financial reports under the project. To strengthen project implementation, mitigation measures have been established and will be closely monitored to ensure that the residual FM risk remains moderate, including: (i) formal internal control framework is described in the project’s Operations Manual; (ii) flow of funds mechanism via a commercial bank acceptable to the Bank; (iii) project financial statements to be audited by independent auditors and on terms of reference acceptable to the Bank; and (iv) regular FM implementation support and supervision. Procurement performance is rated as Satisfactory per most recent ISR and procurements are generally progressing according to plans and is being implemented through the Bank’s STEP system. Procurement staff at the PIU has undergone several procurement trainings and their capacities are considered sufficient to handle project procurement. 20. Project Risks. The overall risk to achievement of the PDO is Moderate, as implementation is progressing. Macroeconomic risk is rated Substantial, as the overall macroeconomic situation of Tajikistan has improved. Following the substantial slowdown in 2020, the economy has rebounded, and the gross domestic product (GDP) grew at 8.7 percent in the first half of 2021, driven by increases in precious metal prices, and also in private investment and consumption. Nevertheless, the recovery remains fragile and dependent on the regional and local epidemiological situation and the rollout of the national vaccination program not only in Tajikistan, but also in other countries in the region. The inflation rate declined from the peak registered in March 2021, but rising demand on fuel and bottleneck in global supply chains are exerting an upward pressure on import prices. The macroeconomic situation presents potential risks as high inflation rate could pose risks to procurement carried out in local currency. Consequently, the residual macroeconomic risk remains Substantial. The technical design risk is Moderate, given that the TSG is gaining more experience and operational engagement is increasing. All other risks (Political and Governance, Sector Strategies, Institutional Capacity for Implementation, Fiduciary, Environment and Social and Stakeholders) are rated as Moderate. III. SUMMARY OF CHANGES Changed Not Changed Results Framework ✔ Components and Cost ✔ Loan Closing Date(s) ✔ Reallocation between Disbursement Categories ✔ Disbursement Estimates ✔ Implementation Schedule ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ PBCs ✔ Cancellations Proposed ✔ The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) Disbursements Arrangements ✔ Overall Risk Rating ✔ Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_COMPONENTS_TABLE COMPONENTS Current Current Proposed Proposed Cost Action Component Name Component Name Cost (US$M) (US$M) Component 1: Performance- Component 1: Performance- 19.83 Revised 19.44 Based Financing Based Financing Component 2: Primary Health Component 2: Primary Health 18.48 Revised 18.87 Care Strengthening Care Strengthening Component 3: Project Component 3: Project Management, Coordination, and 6.76 Management, Coordination, 6.76 Monitoring & Evaluation and Monitoring & Evaluation TOTAL 45.07 45.07 OPS_DETAILEDCHANGES_LOANCLOSING_TABLE The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-56660 Closed 31-Dec-2019 23-Jul-2020 30-Sep-2020, 08- IDA-D0700 Closed 31-Dec-2019 Feb-2021 IDA-D5470 Effective 30-Jun-2022 30-Jun-2023 30-Oct-2023 31-Dec-2019, 23-Jul- IDA-H8790 Closed 31-Jan-2019 2020 31-Dec-2019, 23-Jul- TF-14871 Closed 31-Jan-2019 2020 TF-B2817 Effective 31-Dec-2021 31-Dec-2022 30-Apr-2023 OPS_DETAILEDCHANGES_REALLOCATION _TABLE REALLOCATION BETWEEN DISBURSEMENT CATEGORIES Financing % Current Allocation Actuals + Committed Proposed Allocation (Type Total) Current Proposed IDA-D5470-001 | Currency: XDR iLap Category Sequence No: 1 Current Expenditure Category: PBF Scheme under Component 1(a) 1,700,000.00 0.00 1,306,721.49 100.00 100.00 iLap Category Sequence No: 2 Current Expenditure Category: G,W,NonCS,CS,PBF costs 1b,TR,IOC 5,000,000.00 1,187,113.55 5,117,268.50 100.00 100.00 iLap Category Sequence No: 3 Current Expenditure Category: W under Comp 2.2 (iii) 600,000.00 0.00 876,010.01 100.00 100.00 Total 7,300,000.00 1,187,113.55 7,300,000.00 TF-B2817-001 | Currency: USD iLap Category Sequence No: 1 Current Expenditure Category: PBF Scheme under Component 1(a) The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) 960,000.00 505,775.07 960,000.00 100.00 100.00 iLap Category Sequence No: 2 Current Expenditure Category: PBFcos1b;G,CS,TR-C1dii+iv,C2.2ii+iv 1,040,000.00 516,820.86 1,040,000.00 100.00 100.00 Total 2,000,000.00 1,022,595.93 2,000,000.00 OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Change in Disbursement Estimates Yes Year Current Proposed 2014 1,350,000.00 1,000,000.00 2015 2,573,514.15 2,400,000.00 2016 4,136,661.54 3,400,000.00 2017 4,784,218.19 3,800,000.00 2018 5,874,279.55 5,000,000.00 2019 7,189,546.89 6,000,000.00 2020 3,173,063.63 2,800,000.00 2021 6,359,358.02 1,200,000.00 2022 6,359,358.03 5,195,116.00 . The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) . Results framework COUNTRY: Tajikistan Tajikistan Health Services Improvement Project (HSIP) Project Development Objectives(s) The revised PDO is to contribute to the improvement of the coverage and quality of basic primary health care (PHC) services in selected districts. Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Coverage of basic Primary Health Care (PHC) services in selected districts Mothers receiving timely postnatal counselling in existing districts 90.00 92.00 93.00 94.00 95.00 (Percentage) Rationale: Action: This indicator has been Adjustments to results indicators (intermediate and end-target values) are made to align the Results Framework with the proposed closing date Revised extension. Mothers receiving timely postnatal counselling in new 60.00 90.00 91.00 92.00 93.00 districts (Percentage) Rationale: Action: This indicator has been Adjustments to results indicators (intermediate and end-target values) are made to align the Results Framework with the proposed closing date Revised extension. Number of mothers counselled on 182,452.00 213,911.00 266,419.00 281,319.00 290,512.00 nutrition (Number) The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Rationale: Action: This indicator has been Adjustments to results indicators (intermediate and end-target values) are made to align the Results Framework with the proposed closing date Revised extension. Quality of basic Primary Health Care (PHC) services in selected districts 60% (average among 88% (average among 80% (average among 83% (average among 85% (average among Average Health Facility Quality of participating districts, RHCs) participating districts, RHCs), participating districts, participating districts, participating districts, RHCs), Care Score in existing project 50.6% (average among 86% (average among RHCs),80% (average among RHCs),73% (average among 84% (average among districts (Text) participating districts, HHs) participating districts, HHs) participating districts, HHs) participating districts, HHs) participating districts, HHs) Action: This indicator has been Revised Average Health Facility Quality Rural health center 55 Rural health center 60 Rural health center 63 Rural health center 63 Rural health center 65 percent of Care Score in new project percent percent percent percent Health House 55 percent districts (Text) Health House 50 percent Health House 55 percent Health House 55 percent Health House 55 percent Action: This indicator has been Revised PDO Table SPACE Intermediate Results Indicators by Components RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Component 1: Performance Based Financing Number of eligible health facilities 449.00 720.00 720.00 720.00 in which PBF is initiated (Number) The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Action: This indicator has been Revised Percentage of Primary Health Care facilities eligible for PBF payments who received timely PBF payments 100.00 100.00 100.00 100.00 in the preceding quarter (Percentage) Action: This indicator has been Revised Number of independent verification visits completed per 10.00 11.00 12.00 14.00 schedule (Number) Action: This indicator has been Revised Percentage of hypertension patient charts with treatment according to 80.00 97.00 97.00 97.00 98.00 protocol in existing districts (Text) Action: This indicator has been Revised Percentage of hypertension patient charts with treatment 20.00 88.00 88.00 89.00 according to protocol in new districts (Text) Action: This indicator has been Revised Number of citizen scorecard exercises/sessions conducted in the 288.00 288.00 522.00 816.00 816.00 project districts. (Number) The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Action: This indicator has been Revised Average proportion of women attending citizen scorecard 0.00 10.00 20.00 23.00 25.00 exercises (Percentage) Action: This indicator has been Revised Percentage of PHC facilities that act on community action plans 0.00 5.00 15.00 18.00 20.00 (Percentage) Action: This indicator has been Revised People who have received essential health, nutrition, and population 1,102,806.00 1,506,237.00 2,037,047.00 2,083,056.00 2,230,685.00 (HNP) services (CRI, Number) Action: This indicator has been Revised People who have received essential health, nutrition, and population (HNP) services - 1,166,908.00 1,268,382.00 1,337,508.00 1,343,508.00 1,364,483.00 Female (RMS requirement) (CRI, Number) Action: This indicator has been Revised Number of children immunized 163,699.00 207,636.00 254,255.00 262,256.00 271,695.00 (CRI, Number) The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Action: This indicator has been Revised Number of women and children who have received basic 939,107.00 1,276,601.00 1,720,792.00 1,750,800.00 1,878,990.00 nutrition services (CRI, Number) Action: This indicator has been Revised Number of deliveries attended by skilled health personnel (CRI, 0.00 22,000.00 62,000.00 70,000.00 80,000.00 Number) Action: This indicator has been Revised Percentage of PBF facilities completing household engagement 0.00 30.00 35.00 40.00 45.00 exercise (Percentage) Action: This indicator has been Revised Component 2: Primary Health Care Strengthening Health personnel receiving training 10,289.00 12,800.00 13,000.00 13,500.00 13,700.00 (Number) Action: This indicator has been Revised Health facilities rehabilitated 403.00 403.00 419.00 425.00 and/or equipped (Number) Action: This indicator has been Revised The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Component 3: Project Management, Coordination, and Monitoring & Evaluation Number of new project districts in which PBF MIS is operational 0.00 6.00 6.00 6.00 6.00 (Number) Action: This indicator has been Revised IO Table SPACE The World Bank Tajikistan Health Services Improvement Project (HSIP) (P126130)