The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) Tajikistan Health Services Improvement Project (HSIP) (P126130) EUROPE AND CENTRAL ASIA | Tajikistan | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2014 | Seq No: 18 | ARCHIVED on 18-Jun-2022 | ISR51712 | Implementing Agencies: Ministry of Health & Social Protection, Ministry of Health & Social Protection Project Coordination Group, Republic of Tajikistan Key Dates Key Project Dates Bank Approval Date: 30-Jul-2013 Effectiveness Date: 11-Dec-2013 Planned Mid Term Review Date: 27-Mar-2017 Actual Mid-Term Review Date: 27-Mar-2017 Original Closing Date: 31-Jan-2019 Revised Closing Date: 30-Jun-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) 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. 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) The revised PDO is to contribute to the improvement of the coverage and quality of basic primary health care (PHC) services in selected districts. Components Table Name Component 1: Performance-Based Financing:(Cost $19.44 M) Component 2: Primary Health Care Strengthening:(Cost $18.87 M) Component 3: Project Management, Coordination, and Monitoring & Evaluation:(Cost $6.76 M) 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 Moderate Moderate Implementation Status and Key Decisions Following the signing of the legal agreements by the Government of Tajikistan on November 16, 2020 and their ratification by the Parliament on January 28, 2021, the Second Additional Financing for the Health Services Improvement Project was declared effective on February 9, 2021. Implementation of key activities is progressing well and has gradually intensified under all Project components. Activities under the Second Additional Financing have continued to build upon substantial results achieved thus far. As of April 30, 2022, the following cumulative results have been achieved: • 13,739 health workers were trained (exceeding the end target of 13,700); 6/18/2022 Page 1 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) • 721 health facilities initiated Performance-Based Financing (exceeding the end target of 720); • 51.6 percent of PBF facilities have completed household engagement exercises (exceeding the end target of 45 percent) • 403 health facilities were equipped with medical bags, equipment, laptops/tablets to deliver quality primary health care (the end target is 425). The Project has also contributed to improvement in the coverage of health services: • percentage of pregnant women who received timely postnatal counseling increased from 90 percent and 68 percent in existing and new districts, respectively, in 2019 to 99.2 percent and 96.9 percent in 2022. • number of mothers counselled on nutrition increased from 182,452 sessions in 2019 to 225,053 in 2022. There have also been positive results for key indicators measuring quality of primary health care provided in Project-supported facilities receiving Performance-Based Financing bonuses: • overall, quality scores for rural health centers have risen from 6 percent and 55 percent in 2019 in existing and new districts, respectively, to 88 percent and 66 percent in 2022 . For health houses, during the same period, the quality scores have increased from 51 percent and 50 percent for existing and new districts, respectively to 86 percent and 59 percent, respectively, over the same period. • percentage of hypertension patients treated according to protocol has increased from 80 percent and 20 percent in existing and new districts, respectively, in 2019 to 98 percent and 89 percent, respectively, in 2022. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Moderate Moderate Macroeconomic -- Substantial Substantial Sector Strategies and Policies -- Moderate Moderate Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and -- Moderate Moderate Sustainability Fiduciary -- Moderate Moderate Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Moderate Moderate Results PDO Indicators by Objectives / Outcomes Coverage of basic Primary Health Care (PHC) services in selected districts IN01149374 ►Mothers receiving timely postnatal counselling in existing districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/18/2022 Page 2 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) Value 90.00 98.69 99.15 95.00 Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 IN01149391 Mothers receiving timely postnatal counselling in new districts (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 98.04 96.94 93.00 IN01149392 ►Number of mothers counselled on nutrition (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 182,452.00 206,212.00 225,053.00 290,512.00 Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 Quality of basic Primary Health Care (PHC) services in selected districts IN01149373 ►Average Health Facility Quality of Care Score in existing project districts (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 60% (average among 87% (average among 87.9% (average 88% (average among participating districts, participating districts, among participating participating districts, RHCs) RHCs) districts, RHCs) RHCs), 86% (average Value 50.6% (average among 84% (average among 86.3% (average among participating participating districts, participating districts, among participating districts, HHs) HHs) HHs) districts, HHs) Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 IN01149375 Average Health Facility Quality of Care Score in new project districts (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target RHC 55% RHC 62.9% RHC 66.5% RHC 65% Value HH 50% HH 56.8% HH 58.8% HH 55% Intermediate Results Indicators by Components Component 1: Performance Based Financing IN01149393 ►Number of eligible health facilities in which PBF is initiated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 449.00 457.00 721.00 720.00 Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 6/18/2022 Page 3 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) All facilities received payments for Q4 of 2021. Payments for Q1 of 2022 will be paid in June. Comments: IN01149396 ►Percentage of Primary Health Care facilities eligible for PBF payments who received timely PBF payments in the preceding quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 100.00 100.00 100.00 100.00 Date 22-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 IN01149398 ►Number of independent verification visits completed per schedule (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 10.00 11.00 14.00 Date 11-Oct-2019 15-Dec-2020 22-Apr-2022 31-May-2023 Independent verification visits have not yet been completed. This indicator remains unchanged. Comments: IN01149399 ►Percentage of hypertension patient charts with treatment according to protocol in existing districts (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 80% Value 97.6% 98.3% 85% Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 Comments: IN01149400 Percentage of hypertension patient charts with treatment according to protocol in new districts (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 20% 88.88% 89.09% 89% IN01149401 ►Number of citizen scorecard exercises/sessions conducted in the project districts. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 288.00 360.00 538.00 816.00 Date 22-Oct-2019 30-Nov-2021 14-Jun-2022 31-Dec-2022 This is a cumulative indicator, 528 sessions plus baseline (288 sessions) will equal the end target of 816. Comments: IN01149402 Average proportion of women attending citizen scorecard exercises (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 81.50 25.00 6/18/2022 Page 4 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) IN01149403 ►Percentage of PHC facilities that act on community action plans (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 20.00 Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 Indicator remains unchanged as community action plans will be developed after the completion of 1st Comments: round of citizen scorecard sessions. IN01149404 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 1,250,831.00 1,496,681.00 1,503,067.00 2,230,685.00 Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 For the sub-indicator "Number of deliveries attended by skilled health personnel" the Actual Previous Comments: value of 148,025 is erroneous and should be 22,160. IN01149405 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 1,166,908.00 1,300,003.00 1,383,868.00 1,364,483.00 IN01149406 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 163,699.00 190,100.00 207,445.00 271,695.00 Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 IN01149407 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 939,107.00 1,136,396.00 1,257,983.00 1,878,990.00 Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-Mar-2023 IN01149408 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 148,025.00 37,639.00 80,000.00 Date 01-Oct-2013 30-Nov-2021 22-Apr-2022 31-Dec-2019 IN01149409 6/18/2022 Page 5 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) ►Percentage of PBF facilities completing household engagement exercise (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 36.40 51.60 45.00 Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 Component 2: Primary Health Care Strengthening IN01149394 ►Health personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10,287.00 13,614.00 13,739.00 13,700.00 Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 237 PHC staff were trained in the existing 10 project districts as part of the training on the revised PBF Comments: Manual (164 doctors, 60 nurses, and 13 other PHC staff). IN01149397 ►Health facilities rehabilitated and/or equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 403.00 417.00 403.00 425.00 Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 The "Actual Previous" should be 403, the number 417 is an error. There has been no progress on this indicator during the reporting period as rehabilitation is still ongoing and will only be completed during next Comments: reporting period. Component 3: Project Management, Coordination, and Monitoring & Evaluation IN01149395 ►Number of new project districts in which PBF MIS is operational (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6.00 6.00 6.00 Date 11-Oct-2019 30-Nov-2021 22-Apr-2022 31-May-2023 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) 6/18/2022 Page 6 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P126130 IDA-56660 Closed USD 5.50 5.50 0.00 5.57 0.00 100% P126130 IDA-D0700 Closed USD 4.50 4.50 0.00 4.63 0.00 100% P126130 IDA-D5470 Effective USD 10.00 10.00 0.00 5.14 4.82 52% P126130 IDA-H8790 Closed USD 15.00 15.00 0.00 14.09 0.00 100% P126130 TF-14871 Closed USD 4.80 4.80 0.00 4.80 0.00 100% P126130 TF-B2817 Effective USD 2.00 2.00 0.00 2.00 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P126130 IDA-56660 Closed 22-Jun-2015 07-Aug-2015 04-Dec-2015 31-Dec-2019 31-Dec-2019 P126130 IDA-D0700 Closed 22-Jun-2015 07-Aug-2015 04-Dec-2015 31-Dec-2019 30-Sep-2020 P126130 IDA-D5470 Effective 18-Dec-2019 16-Nov-2020 09-Feb-2021 30-Jun-2022 30-Jun-2023 P126130 IDA-H8790 Closed 30-Jul-2013 20-Sep-2013 11-Dec-2013 31-Jan-2019 31-Dec-2019 P126130 TF-14871 Closed 20-Sep-2013 20-Sep-2013 11-Dec-2013 31-Jan-2019 31-Dec-2019 P126130 TF-B2817 Effective 16-Nov-2020 16-Nov-2020 09-Feb-2021 31-Dec-2021 31-Dec-2022 Cumulative Disbursements 6/18/2022 Page 7 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) Restructuring History Level 2 Approved on 08-Aug-2018 ,Level 2 Approved on 12-Sep-2019 ,Level 2 Approved on 24-Dec-2021 Related Project(s) P153975-Additional Financing to TJ Health Services Improvement Project ,P170358-Second Additional Financing to the Tajikistan Health Services Improvement Project 6/18/2022 Page 8 of 8