OFFICIAL T DOCUMENTS Supplemental Letter No. 2 REPUBLIC OF TAJIKISTAN September 20, 2013 International Development Association 1818 H Street, N.W. Washington, D.C. 20433 United States of America Re: Grant No. H8790-TJ (Health Services Improvement Project) Performance Monitoring Indicators This refers to paragraph A of Section II of Schedule 2 to the Financing Agreement of this date between Republic of Tajikistan (the Recipient) and the International Development Association (the Association) for the above-captioned Project. The Recipient hereby confirms to the Association that the indicators set forth in the attachment to this letter shall serve as a basis for the Recipient to monitor and evaluate the progress of the Project and the achievement of the objective thereof. Very truly yours, REPUBLIC OF TAJIKISTAN By Authorized Representative Attachment Attachment to Supplemental Letter No. 2 REPUBLIC OF TAJIKISTAN Health Services Improvement Project Performance Monitoring Indicators Project Development Objective The Project Development Objective is to contribute to the improvement of the coverage and quality of basic Primary Health Care (PHC) services in rural health facilities in selected regions PDO level Cumulative Target Values Responsibility Description Results 0 measoetBaseline Year erFrequency Methool for Data (Indicator Indicators measurement Year 1 2 3 4 Year 5 Year Collection , definition etc.) 79.2% 79.2%' 85%- Semi-annual PBF MIS Number ofpregnant Sogd Sogd Sogd (PBF MIS database women in Project 39.2% 45% database) districts receiving ante Kl9lon Khalon natal care four or more K h a ti o n Kti m e s f r o m a s k ille d of [World 39.2% provider Percentage Bank Khadon pregnant 2012] Ml women MoH receiving Household Coordination antenatal % (and Survey: YI Group Numerator Number of care four or number) & Y5 Household pregnant women in more times Survey Project districts from a skilled receiving ante natal health care four or more provider times from a skilled provider Denominator: Total number ofpregnant women in Project districts To be disaggregated for Sogd and Khalon Data source for percentage: IHS: Data source for number: PBF MIS Semi-annual PBF MIS Moll Number of women in 30.7% 30.7% 35% (PBF MIS database Coordination Project districts aged Sogd Sogd Sogd database) Group 15-49 years who are currently using a 22.9% 22.9% 27% modem method of Khation Khatlon Khatlon Household Family Planning [Source: Survev: YI DIIS & Y5 Household 2012] survey Numerator: Number of women in Project districts aged 15-49 years who are currently Contraceptive % (amd using a modem method Prevalence number) of Family Planning Rate Denominator: Number of women in Project districts aged 15-49 years who are currently married To be disaggregated for Sogd and Khatlon Data source for percentage: HHS: Data source for number: PBF MIS Average Mean quality To be To be Semi-annual PBF MIS MoH Composite Health Health score estimated estimated (PBF MIS database Coordination Facility Quality Score Facility database) Group covering domains of Quality of (Quality score staffing, functional Care Score rangesfrom 0- equipment and drugs/ 100) Health supplies available and Facility Iealth Facility criterion based audit. Survey: Yl Surveyi Each facility would be & Y5 scored on each item in the index to create a facility score that ranges from 0-100. The mean for allfacilities would then be computed To be disaggregated for Sogd and Khatlon 79.2% 79.2% 85% Semi-annual PBF MIS MoH Number of children Sogd Sogd Sogd (PBF MIS database Coordination under-five with database) Group diarrhea in Project districts visiting Rural 68.2% 68.2% 74% Health Centers or Khatlon KhatIon Khatlon Health Houses treated with any ORT Percentage of children [Source: under-five DHS with diarrhea 2012] treated with any Oral Rehydration 7herapy Household survey: Yl Numerator: Number of & Y5 Household children under-five survey with diarrhea in Project districts visiting Rural Health Centers or Health Houses treated with any ORT Denominator: Number of children under-five with diarrhea in Project districts visiting Rural Health Centers or Health Houses To be disaggregated for Sogd and Khatlon Data source for percentage: HFS: Data source for number: PBF MIS Intermediate Units of Cumulative Target Values fr4uency- Data Source/ Responsibility Description Level Unt f Bseline Yearny- DtaSure for Data (niao Results measurement Ba Year Year Year Year 4 Year 5 cy Methodology ollection eniictc) Indicators 1 ______ 1 2 3 Year 6 oy Cleto eiiinec) Component I: Performance Based Financing Number of Rural Health Numberof P1F MIS MoH (enters that eligible Semi-annual database Coordination have received health (P3FMI roupfisPB facilities in Number 0 TBD TBD TBI) TBD TBD TBD database) payment which PBF is initiated To be disaggregated for Sogd and Khatlon Percentage of % 0 60% 1Semi-annual PBF MIS MoH Numerator: Pray --- t I I (PBF MIS database Coordination Number of Health Care database) Group Rural Health facilities Centers in eligible for Project districts PBF 100% who received payments quarterly PBF who received payment within timely PBF [TBD] days of payments in quarter ending the preceding in the most quarter recentlv completed quarter Denominator: Number of Rural Health Centers in Project districts who were eligible for payment based on first verification report (ex-ante verification) To be disaggregated for Sogd and Khation Number of independent Number of PBF MIS MoH verification independent Semi-annual database Coordination reports verification Number per (PBF MIS Grou completed by visits year 0 1 2 8 8 8 database) third party completed %erification per schedule agency as 8 scheduled, i.e., one report per ___________rayon every six months To be disaggregated for Sogd and Khation Household Household MoH Numerator: TBD TBD Survey: YI Survey Coordination Number of & Y5 Group adults (18-) in Project districts who are currentlv on anti- hypertensive Percentage of treatment hypertensive Denominator: adults who Number of are currently adults in receiving Project anti- districts who hypertensive are treatment hypertensive Disaggregated withn Sogd and Khation respectively by age: (1) 18-39 years; (2) 40+ years Numerator: Percentage of Number of hypertensive adult patients who Semi-annual Moodi o hypertensive are receiving % (and (PBF MIS PBF MIS Coordination patients (18+) correct anti- number) TBD TBD database) Group at Project hypertensive TBD TBD TBD TBD TBD facilities who treatment per are currently protocols receiving ___________ ____ ____________________ ___________________correct anti- hypertensive treatment per clinical protocols Denominator: Number of adult hypertensive patients in Project facilities: Disaggregated within Sogd and Khation respectively by age: (l) 18-39 years; (2) 40+ years TBD Semi-annual PBF AIS MoH Number of 0 T1D TBD TBD TBD TBD (PBF MIS database Coordination pregnant or database) Group lactating women or children under Number of age 5 years in N er of/ Project pregnant/ districts lactating reached by women and x growth or children Number monitoring, under age 5 nutritional reached bynurtoa basich counselling or basicio demonstration nutrition services services supported by the World Bank To be disaggregated within Sogd and Khadon by: () Pregnant/ lactating women; (ii) Children under age 24 months; (iii) Children age 24 months to 5 years Component 2 - Primary Health Care Strengthening This includes the following: (i) Doctors and nurses in Project and comparison districts who have received Family Medicine training; (ii) TBD Semi-annual PBF MIS MoH Doctors and Health x (PBF MIS database Coordination nurses who personnel Number 0 TBD TBD TBD TBD TBD database) Group have received receiving training on training Non Communicable Disease protocols; (iii) Doctors and nurses who have received training on Maternal and Child Health protocols: (iv) Primary Health ____ __________ _______ __________Care managers and supervisors trained on quality supervision; (v) Staff trained on PBF supervision, verification and implementation To be disaggregated within Sogd and Khatlon by (i) to (v) listed above Number of Rural Health Centers and Health Houses in Project districts Number of PBF MIS constructed, health Semi-annual dBa MoH renovated or facilities x (PBF MIS Cdbs equipped in constructed. Number 0 3 6 6 6 24 24 database) Coordination accordance renovated Group with sound and/ or environmental equipped requirements To be disaggregated for Sogd and Khation Component 3: Project Management Number of Number of MoH districts in Project PBF Progress Coordination which the PBF districts in Semi-annual report Group MIS is used to which PBF Number 0 1 3 8 8 8 8 transmit PBF IS is data operational electronically from districts to Mot I CG Report on evaluation of "Yes" response pilot indicates that experience Mol both evaluation completed Yes/ No No No Yes N/Al N/A N/A N/A N/A PBF Progress Coordination report and and action report Group action plan for plan for the roll out has roll-out been prepared completed 1 N/A- not applicable Results Framework and Monitoring Country: Tajikistan Project Name: Health Services Improvement Project (P126130) Results Framework Project Development Objective Indicators Indicator Name Description (indicator definition etc.) Percentage of pregnant women receiving antenatal care Number of pregnant women in Project districts receiving ante natal care four or more four or more times from a skilled health provider times from a skilled provider Numerator: Number of pregnant women in Project districts receiving ante natal care four or more times from a skilled provider Denominator: Total number of pregnant women in Project districts To be disaggregated for Sogd and Khatlon Contraceptive Prevalence Rate Number of women in Project districts aged 15-49 years who are currently using a modem method of Family Planning Numerator: Number of women in Project districts aged 15-49 years who are currently using a modern method of Family Planning Denominator: Number of women in Project districts aged I5-49 years who are currently married To be disaggregated for Sogd and Khatlon Average Health Facility Quality of Care Score Composite Health Facility Quality Score covering domains of: staffing, functional equipment and drugs/ supplies available and criterion based audit. Each facility would be scored on each item in the index to create a facility score that ranges from 0-100. The mean for all facilities would then be computed To be disaggregated for Sogd and Khatlon Percentage of children under-five with diarrhea treated Number of children under-five with diarrhea in Project districts visiting Rural Health with any Oral Rehydration Therapy Centers or Health Houses treated with any ORT Numerator: Number of children under-five with diarrhea in Project districts visiting Rural Health Centers or Health Houses treated with any ORT Denominator: Number of children under-five with diarrhea in Project districts visiting Rural Health Centers or Health Houses Intermediate Results Indicators Indicator Name Description (indicator definition etc.) Component 1: Performance Based Financing Number of eligible health facilities in which PBF is Number of Rural Health Centers that have received first PBF payment. initiated To be disaggregated for Sogd and Khation Percentage of Primary Health Care facilities eligible for Numerator: Number of Rural Health Centers in Project districts who received PBF payments who received timely PBF payments in the quarterly PBF payment within [TBD] days of quarter ending in the most recently preceding quarter completed quarter Denominator: Number of Rural Health Centers in Project districts who were eligible for payment based on first verification report (ex-ante verification) To be disaggregated for Sogd and Khatlon Number of independent verification visits completed per Number of independent verification reports completed by third party verification schedule agency as scheduled, i.e., one report per rayon every six months To be disaggregated for Sogd and Khatlon Percentage of hypertensive adults who are currently Numerator: Number of adults (18+) in Project districts who are currently on anti- receiving anti-hypertensive treatment hypertensive treatment Denominator: Number of adults in Project districts who are hypertensive Disaggregated within Sogd and Khatlon respectively by age: (1) 18-39 years; (2) 40+ years Percentage of hypertensive patients who are receiving Numerator: Number of adult hypertensive patients (18+) at Project facilities who are correct anti-hypertensive treatment per protocols currently receiving correct anti-hypertensive treatment per clinical protocols Denominator: Number of adult hypertensive patients in Project facilities; Disaggregated within Sogd and Khatlon respectively by age: (1) 18-39 years; (2) 40+ years Number of pregnant/ lactating women and/ or children Number of pregnant or lactating women or children under age 5 years in Project under age 5 reached by basic nutrition services districts reached by growth monitoring, nutritional counselling or demonstration services supported by the World Bank To be disaggregated within Sogd and Khatlon by: (i) Pregnant/ lactating women; (ii) Children under age 24 months; (iii) Children age 24 months to 5 years Component 2 - Primary Health Care Strengthening Health personnel receiving training This includes the following: (i) Doctors and nurses in Project and comparison districts who have received Family Medicine training; (ii) Doctors and nurses who have received training on Non Communicable Disease protocols; (iii) Doctors and nurses who have received training on Maternal and Child Health protocols; (iv) Primary Health Care managers and supervisors trained on quality supervision; (v) Staff trained on PBF supervision, verification and implementation Number of health facilities constructed, renovated and/ or Number of Rural Health Centers and Health Houses in Project districts constructed, equipped renovated or equipped in accordance with sound environmental requirements To be disaggregated for Sogd and Khatlon Component 3: Project Management Number of Project districts in which PBF MIS is Number of districts in which the PBF MIS is used to transmit PBF data electronically operational from districts to MoH CG Report on evaluation of pilot experience completed and "Yes" response indicates that both evaluation report and action plan for roll out has action plan for the roll-out prepared been completed