Public Disclosure Copy The World Bank Implementation Status & Results Report Liberia Health Systems Strengthening (P128909) Liberia Health Systems Strengthening (P128909) AFRICA | Liberia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2013 | Seq No: 13 | ARCHIVED on 20-Nov-2019 | ISR39093 | Implementing Agencies: Republic of Liberia, Ministry of Health, MOH Project Implementation Unit Key Dates Key Project Dates Bank Approval Date: 30-May-2013 Effectiveness Date: 16-Jun-2014 Planned Mid Term Review Date: 03-Dec-2018 Actual Mid-Term Review Date: 03-Dec-2018 Original Closing Date: 30-May-2018 Revised Closing Date: 30-May-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to improve the quality of maternal health, child health, and infectious diseaseservicesin selected secondary-level health facilities. 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 new proposed PDO is to improve the quality of primary and secondary health care services, with a focus on maternal, neonatal and child health. Components Table Name Support to Quality Service Delivery Systems:(Cost $19.70 M) Support to strengthening fit-for-purpose health workforce:(Cost $2.70 M) Project Management:(Cost $2.00 M) Support to strengthening critical services and support Systems:(Cost $6.60 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions 11/20/2019 Page 1 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Liberia Health Systems Strengthening (P128909) Implementation is progressing as planned for all activities, and the project now needs to start planning for the project exit strategy as it closes in May 2020. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Substantial Substantial Sector Strategies and Policies -- Moderate Moderate Technical Design of Project or Program -- Low Low Institutional Capacity for Implementation and Sustainability -- Moderate Moderate Fiduciary -- Moderate Moderate Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improve quality of primary/secondary health care services on maternal, neonathal and child health IN00760322 ►Average Quality of Care score of target PBF hospitals (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 76.50 72.55 65.00 Date 30-Apr-2017 31-Dec-2018 30-Jun-2019 30-May-2020 This indicator statement was revised from the original "Health Facility Quality Index score improvement at Target PBF hospitals and facilities" for better clarity since the change of the quality index score will be reported as a trend over each subsequent verification period. The project reports the average quality score following every independent verification by the National Verification Agency. Reporting is being changed from "percentage" to "number". Comments: The value of the previous reporting for 29 June 2018, 61.93%, was the average quality score for three hospitals (C.B. Dunbar, Phebe and Redemption) in the phase one rollout. The current reporting (October - December 2018 - 76.5%) is the average quality of care score for all six hospitals (phase one and phase two). "Average Quality of care score of target PBF hospitals" This report quarterly as follow: Jan-Mar 2019 (80.45%); April- June (72.55%) quarter April to June score reflects two additional hospitals St. Francis and 11/20/2019 Page 2 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Liberia Health Systems Strengthening (P128909) Chief Jallalone (Phase 3) + the existing six hospitals C.B. Dunbar, Phebe, Tellewoyan, FJ Grante, JF Doe and Redemption (phase one and phase two). IN00760323 ►Maternal death audits carried out routinely by PBF target hospitals according to national maternal death audit guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 47.60 58.40 65.00 Date 03-Jan-2013 31-Dec-2018 30-Jun-2019 30-May-2020 The indicator statement was revised from the original "Maternal death audits carried out routinely by PBF target hospitals" for better clarity - now includes audit done according to national technical guidelines, as verified by the National Verification agency. The value of the previous reporting for 31 December 2018, 47.6%, was for six hospitals (C.B. Dunbar, Phebe, Tellewoyan, FJ Grante, JF Doe and Redemption) in the phase one and phase two rollout. The Comments: current reporting for 30 June 2019, 58.4%, is for eight hospitals (phase one, phase two and phase three). The end target is for eight hospitals. End target remains 65.00 which is the realistic estimate based on the current progress to date. “Maternal death audits carried out routinely by PBF target hospitals according to national maternal death audit guidelines” for period January 2018-June 2019 (58.4%=62/106*100). IN00760324 ►Doctors, clinicians and other MoH-approved staff who receive hazard payment for provision of EVD-related services. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 28,537.00 28,537.00 28,537.00 Date 27-Feb-2015 27-Feb-2015 27-Feb-2015 16-May-2016 IN00760325 ►Neonatal death audits carried out routinely by PBF target hospitals according to national neonatal death audit guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 40.90 67.00 45.00 Date 15-Jan-2017 31-Dec-2018 30-Jun-2019 30-May-2020 The indicator statement was changed. The original indicator statement was: "Neonatal death audits carried out routinely by PBF target hospitals". The value of actual previous is a representation of the neonatal audit done according to the national technical guidelines for neonatal death audit and verified for three hospitals (C.B. Dunbar, Phebe and Redemption) in the phase one rollout. The Current (Actual) data (40.9%, December 31, 2018), is a representation of the neonatal audit done according to guideline and verified for all six hospitals. Comments: Actual (Previous) should be 14.8% (31 December 2017) but the system does not allow to reflect the change. End Target has been changed to 45.00 which is the realistic estimate based on the current progress to date. “Neonatal death audits carried out routinely by PBF taret hospitals according to national neonatal death audit guidelines” for the period of January 2019- June 2019 (67%=163/243). IN00760341 ►Mothers who have a postpartum visit within 24 hours of delivering (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 76.50 80.45 80.00 Date 31-Dec-2015 31-Dec-2018 30-Jun-2019 30-May-2020 11/20/2019 Page 3 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Liberia Health Systems Strengthening (P128909) The DHIS2 is collecting data for Post-natal care visit within 24 hrs and not within 2 days. This has been changed as part of the RF restructuring completed. "Mothers who have a postpartum visit within 24 hours after delivery” for the period January-June 2019 Comments: (80.45 =104714/130148 live births) reported in number. Intermediate Results Indicators by Components Support to Quality Service Delivery Systems IN00760345 ►Number of new users of modern contraceptive methods (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 123,165.00 726,516.00 1,370,397.00 700,000.00 Date 31-Dec-2013 31-Dec-2017 30-Jun-2019 31-Dec-2019 This is reported for 10 project target counties (Montserrado, Bong, Nimba, Lofa, Sinoe, Gbarpolu, Rivercess, Grand Cape Mount, Grand Gedeh and Grand Kru). This is a cumulative reporting for every calendar year: 2013 (205,969), Cumulative for 2014 (166,085), Comments: Cumulative for 2015 (215,747), Cumulative for 2016 (309,156), Cumulative for 2017 (210,957), Cumulative for 2018 (183,315), Cumulative for 2019 – till June 30 (79,168). Cumulative from 2013 to Dec. 2018 (1,291,229), Cumulative from 2013 to 2019 June (1,370,397). IN00760348 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 922,315.00 1,536,476.00 1,000,000.00 Date 03-Jan-2013 31-Dec-2018 30-Jun-2019 31-Dec-2019 This indicator captures deliveries by skilled birth providers, children fully immunized and women and children who received basic nutrition services as reported for 10 project targeted counties (Montserrado, Bong, Nimba, Lofa, Sinoe, Gbarpolu, Rivercess, Grand Cape Mount, Grand Gedeh and Grand Kru) reported annually from DHIS. This indicator is a Corporate Result Indicator and has been moved from PDO level to Intermediate Outcomes. The reported data is the cumulative of total of all immunizations. Cumulative data for the total number of Immunization + deliveries by Skilled health personnel for 2013 (168,176), Cumulative for 2014 (127,464), Cumulative for 2015 (147,179), Cumulative for 2016 (182,412), Cumulative for 2017 (213,262), Cumulative for 2018 (410,963), Cumulative from 2013 to Dec. 2018 (1,249,456), Cumulative for 2019 – till June 30 (287,020), Cumulative from 2013 to 2019 June Comments: (1,536,476). Sub-set CRI "Number of Children Immunized": Cumulative for 2013 (93,528), Cumulative for 2014 (63,038), Cumulative for 2015 (76,248), Cumulative for 2016 (94,863), Cumulative for 2017 (114,054), Cumulative for 2018 (115,907), Cumulative from 2013 to Dec. 2018 (557,638), Cumulative for 2019 – till June 30 (59,483). Cumulative from 2013 to 2019 June (617,121). Sub-set CRI "Number of deliveries attended by skilled health personnel": Cumulative for 2013 (74,648), Cumulative for 2014 (64,426), Cumulative for 2015 (70,931), Cumulative for 2016 (87,549), Cumulative for 2017 (99,208), Cumulative for 2018 (100,541), Cumulative from 2013 to Dec. 2018 (497,303), Cumulative for 2019 – till June 30 (54,235). Cumulative from 2013 to 2019 June (551,538). IN00760349 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target 11/20/2019 Page 4 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Liberia Health Systems Strengthening (P128909) Value 0.00 513,076.00 617,121.00 600,000.00 Date 03-Jan-2013 31-Dec-2018 30-Jun-2019 31-Dec-2019 IN00760350 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 409,239.00 551,538.00 500,000.00 Date 03-Jan-2013 31-Dec-2018 30-Jun-2019 31-Dec-2019 Support to strengthening fit-for-purpose health workforce IN00760342 ►Number of doctors receiving in-service training in obstetrics, pediatrics, surgery, and internal medicine (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 51.00 57.00 50.00 Date 22-Apr-2016 29-Jun-2018 30-Jun-2019 30-May-2020 The indicator statement has been changed. The original indicator statement was: "In-service Training in Obstetrics, Pediatrics, Surgery, and internal medicine carried out on 6monthly basis in project target Comments: hospitals and satellite health facilities". The Actual (Current) is 51 (as of June 29, 2018) IN00760346 ►Physicians who complete the post-graduate medical residency program (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 28.00 28.00 40.00 Date 22-Apr-2016 31-Dec-2018 31-Dec-2018 30-May-2020 This indicator is linked to component "Support to strengthening fit-for-purpose health workforce" of the Intermediate Outcomes. Actual (Previous) should be 13 but the system does not allow to reflect the change. The end target has been changed to reflect the realistic situation on ground, including Comments: challenges, with the post graduate medical residency program. No change to the Actual (Current) data. 17 graduates are currently undergoing the post-graduate medical residency program. Project Management IN00760343 ►Number of PIU staff trained (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11.00 14.00 18.00 Date 30-May-2013 31-Dec-2018 30-Jun-2019 30-May-2020 This is a new indicator to monitor Project Management. Original project design did not have the indicator to measure project management. This is being introduced since the new OPCS guidelines require Comments: mapping of indicators by components. Staff trained was 11 (as of 31 December 2018) and End Target is 18 (30 May 30 2020). Number of staff trained for 2019 is 3. 11/20/2019 Page 5 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Liberia Health Systems Strengthening (P128909) Support to strengthening critical services and support Systems IN00760344 ►Number of births registered within one year of birth occurrence (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 7,727.00 59,082.00 15,000.00 Date 31-Dec-2017 31-Dec-2018 30-Jun-2019 31-Dec-2019 The original indicator statement was: "Children under 13 years whose birth was registered in project target counties". The indicator statement has been changed to reflect what is collected and reported by paper- based vital statistics data collected by MoH. While the project is supporting a computerized system, it is yet to be fully functional to provide data, and therefore not being used as the data source for this indicator. Reporting has been changed from “Percentage” to “Number”. Reporting is a cumulative number made for a full calendar year for all 15 counties (entire country). Project additional financing (of which this indicator is a part of) was approved in early 2017 following which activity started and therefore Comments: reporting for full 2017 is not available. Therefore, Baseline (December 31, 2017) has been changed to 0.00, Actual (Previous) is not 6,085 (as reported previously) but the system does not allow to reflect the change, Actual (Current cumulative till December 31, 2018) is 7,727 and cumulative End Target for December 31, 2019 is 15,000. Cumulative for 2016 (7,850), Cumulative for 2017 (8,467), Cumulative for 2018 (7,629), Cumulative for Jan – June 2019 (35,136). Cumulative from 2016 to 2019 June (59,082). IN00760347 ►PBF hospitals reporting discussing grievances received (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 67.00 75.00 90.00 Date 30-May-2013 30-Sep-2018 30-Jun-2019 30-May-2020 The original statement indicator was "Grievances registered related to delivery of project benefits that are actually addressed". It has been changed to reflect data collected at PBF hospitals only. 6 PBF Hospitals quarterly report from 2017 to June 2019: Cumulative (Oct. –Dec.17) 16.7%, Cumulative (Jan. –March.18) 25.0%, Cumulative (Apr.-June. 18) Comments: 50.0%, Cumulative (Jul-Sept. 18) 75.0%, Cumulative (Oct. –Dec. 18) 83.3%, Cumulative (Jan. –Mar. 19) 100.0%. With the additional 2 hospitals on board, Cumulative (Apr.–June. 19) 75.0%. This was because the two new hospitals scored 0 which diluted the 100%. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P128909 IDA-52440 Effective USD 10.00 10.00 0.00 8.63 1.06 89% 11/20/2019 Page 6 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Liberia Health Systems Strengthening (P128909) P128909 TF-14432 Effective USD 5.00 5.00 0.00 3.41 1.59 68% P128909 TF-A4116 Effective USD 16.00 16.00 0.00 6.66 9.34 42% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P128909 IDA-52440 Effective 30-May-2013 03-Jul-2013 16-Jun-2014 30-May-2018 30-May-2020 P128909 TF-14432 Effective 03-Jul-2013 03-Jul-2013 16-Jun-2014 30-May-2018 30-May-2020 P128909 TF-A4116 Effective 22-Mar-2017 22-Mar-2017 21-Jun-2017 30-May-2020 30-May-2020 Cumulative Disbursements Restructuring History Level 1 Approved on 08-Aug-2014 ,Level 2 Approved on 15-Jan-2018 ,Level 2 Approved on 01-Apr-2019 Related Project(s) P162477-Liberia Health Systems Strengthening Project - Additional Financing 11/20/2019 Page 7 of 7