The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Nepal Health Sector Management Reform Program (P160207) SOUTH ASIA | Nepal | Health, Nutrition & Population Global Practice | Requesting Unit: SACSN | Responsible Unit: HSAHP IBRD/IDA | Program-for-Results Financing | FY 2017 | Team Leader(s): Sangeeta Carol Pinto, Amit Bhandari Seq No: 9 | ARCHIVED on 25-Oct-2021 | ISR48338 | Created by: Sangeeta Carol Pinto on 17-Sep-2021 | Modified by: Sangeeta Carol Pinto on 20- Oct-2021 Program Development Objectives PDO Table Program Development Objective (from Program Appraisal Document) The Program Development Objective is to improve efficiency in public resource management systems of the health sector in Nepal. Board Approved Revised Program Development Objective (If program is formally restructured) The Program Development Objective is to improve efficiency in the Federal-level public resource management systems of the health sector in Nepal. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Implementation Status and Key Decisions The Nepal Health Sector Management Reform P4R (HSMRP) has successfully completed Year 5 of the program with verified, full achievement of all eleven Disbursement Linked Indicator Results. The progress has been registered during a particularly difficult period where the Ministry of Health and Population (MOHP) and its various Departments, Divisions and Centers were stretched thin launching a strong public health response to an escalating COVID-19 pandemic in the country. It is evident that the reforms in public procurement, financial management, data for decision making and citizen engagement for accountability were critical in the management of the pandemic and yet were deeply institutionalized so as to not be derailed by the pandemic. All actions on the Program Action Plan are on progressing satisfactorily. The program has disbursed 88.2 percent of Credit for results achieved till Year 4 of implementation. The original Credit of US$150 million is expected to be fully disbursed by October 31, 2021. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P160207 IDA-59130 Effective USD 150.00 150.00 0.00 133.95 17.82 88% Not P160207 IDA-69110 USD 50.00 50.00 0.00 0.00 49.65 0% Effective Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P160207 IDA-59130 Effective 13-Jan-2017 02-Mar-2017 13-Apr-2017 15-Jul-2021 16-Jul-2022 10/25/2021 Page 1 of 13 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Not P160207 IDA-69110 08-Jul-2021 15-Sep-2021 -- 16-Jul-2022 16-Jul-2022 Effective DLI Disbursement Achievement Disbursed amount in Disbursement % for DLI ID DLI Type Description Coc DLI Amount Status Coc DLI Loan: IDA59130-001 % contracts - LMD PPMO Partially 1 Regular XDR 11,497,333.00 9,278,971.78 81 % online portal Achieved Annual report grievances Partially 2 Regular XDR 7,900,667.00 6,422,263.44 81 % addressed web b Achieved % procurements - LMD std Partially 3 Regular XDR 9,629,639.00 7,488,089.07 78 % specifications Achieved % district stores reporting Partially 4 Regular XDR 14,182,210.00 8,228,589.49 58 % based om LMI Achieved % reduction - stock outs of Partially 5 Regular XDR 7,224,945.00 2,911,545.00 40 % tracer drugs Achieved % improvement - EVM Partially 6 Regular XDR 2,419,081.00 1,425,461.40 59 % score over 2014 base Achieved % MOH spending entities Partially 7 Regular XDR 10,810,601.00 7,869,684.03 73 % submit annual pl Achieved % MoH's annual spending Partially 8 Regular XDR 14,978,482.00 11,530,275.58 77 % captured TABUCS. Achieved % audited spending units Partially 9 Regular XDR 11,722,235.00 8,789,090.99 75 % responding OAG Achieved % districts with all facilities Partially 10 Regular XDR 14,373,600.00 10,652,511.20 74 % reportin Achieved Operationalization of the Partially 11 Regular XDR 2,861,207.00 2,694,744.47 94 % citizen feedba Achieved Loan: IDA69110-001 DLR 1.7 95% conts by MD 1 Regular XDR 2,450,000.00 Not Achieved 0.00 thru e-proc Y6 DLR 2.6 MoHP ann reprt 2 Regular XDR 1,400,000.00 Not Achieved 0.00 on status Y6 DLR 3.7a 95% healthcom 3(a) Regular XDR 1,050,000.00 Not Achieved 0.00 by MD on std spec DLR 4.5 eLMIS info Y6 avl 4 Regular XDR 5,900,000.00 Not Achieved 0.00 central and pr DLR 5.3 35% red in 5 Regular XDR 5,850,000.00 Not Achieved 0.00 undstck of trac hlth DLR 7.6a eAWPB usd for 7(a) Regular XDR 1,079,910.00 Not Achieved 0.00 pl and bud MoHP DLR 8.6 95% MoHP spend 8 Regular XDR 3,450,000.00 Not Achieved 0.00 capt by TABUCS/CG 10/25/2021 Page 2 of 13 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) DLR 9.6 80% MoHPspend 9 Regular XDR 3,350,000.00 Not Achieved 0.00 uts resp quer in35 DLR 10.6 DHIS2 report 10 Regular XDR 4,900,000.00 Not Achieved 0.00 70% pub health fac DLR 11.6 MoHP on-site 11 Regular XDR 2,100,000.00 Not Achieved 0.00 sup to 3 govt in 4 DLR 3.7b 80% equip by 3(b) Regular XDR 1,050,000.00 Not Achieved 0.00 MD bsd on std spec DLR 7.6b eAWPB usd fr 7(b) Regular XDR 2,320,090.00 Not Achieved 0.00 95% rem units MoHP Program Action Plan Action Description Establish (by January 2017) and maintain a Health Sector Partner Forum at the MoHP (with annual consultations). Source DLI# Responsibility Timing Timing Value Status Technical Client Recurrent Yearly In Progress Completion Measurement This Action is recurrent and will measured through the period of the Program. Due to COVID-19 pandemic, several thematic health sector partner coordination forums were deployed. These Comments include the COVID Crisis Management Center, Health Cluster Coordination meetings, Technical Working Group meetings on Supply Chain Mgmt. etc Action Description Public Health Service Regulation addresses the health care waste management and infection prevention. Source DLI# Responsibility Timing Timing Value Status Environmental and Social Client Due Date 15-Jul-2020 Completed Systems (a) Regulations of the Public Health Service Act approved by Parliament incorporates health care waste management Completion Measurement and infection control; and (b) Healthcare Waste management Guidelines Updated. Comments Action Description Expand GESI strategy (to include issues of disability, geriatrics and rehabilitation of gender-based violence victims). Source DLI# Responsibility Timing Timing Value Status Environmental and Social Sept 2021 Cabinet Client Other In Progress Systems approval pending Revised GESI strategy to include expanded scope approved; and (b) GESI mainstreamed in the planning, budgeting Completion Measurement implementation and monitoring. Comments Cabinet approval of GESI strategy pending. Action Description Procurement planning and budgeting capacity of the MoHP increased 10/25/2021 Page 3 of 13 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Recurrent Semi-Annually In Progress Electronic Logistics Management and Information System data used for improved Consolidated Annual Procurement Completion Measurement Plan. Comments Action Description Finalize CAPP by August every year. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Recurrent Yearly In Progress Completion Measurement CAPP approval date each year and until the last year of the Program. Comments Action Description MoHP evaluates the implications and the options for establishing a post-shipment quality assurance system Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Due Date 15-Sep-2021 In Progress Completion Measurement Position paper on post-shipment quality assurance system developed and discussed, with agreement on next steps. Position paper developed. Discussion with Technical Working Group constituted by MOHP pending, following which Comments sub-national dissemination will be undertaken. Improve accountability and reporting mechanisms of grants provided by the MoHP to different entities (e.g. grants Action Description provided to autonomous bodies captured by TABUCS). Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Recurrent Continuous In Progress The inclusion of autonomous bodies (academic and hospitals) reporting to the Federal Ministry of Health and Completion Measurement Population will be measured as part of DLI 8. Comments Strengthen MoHP internal control environment: (a) analyze compliance gaps between actual practice & MoH internal Action Description control framework; (b) identify key measures to strengthen internal control within MoH for budget execution control & financial reporting Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Recurrent Continuous In Progress 10/25/2021 Page 4 of 13 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) (a) Analysis Completed; (b) Recommendations Identified, Presented to the relevant PFM committee; and (c) Inform Completion Measurement the Financial Management Strengthening Plan. Comments The MoHP reports credible and material complaints regarding fraud and corruption related to the Program to the Action Description World Bank (annually by September 1) Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Recurrent Yearly In Progress Completion Measurement This Action is recurrent and will be measured for each year of the Program. Comments Learning resource package for environmental health care waste management and WASH modules deployed Action Description nationally and sub-nationally through Training of Trainers approach Source DLI# Responsibility Timing Timing Value Status Environmental and Social Client Recurrent Yearly Not Yet Due Systems TOTs completed in all seven provinces with support of Provincial Training Center Completion Measurement Comments TOT completed in all provinces on Social Accountability guidelines with support of Provincial Training Centers for Action Description conduct of timely and quality Social Audits Source DLI# Responsibility Timing Timing Value Status Environmental and Social DLI 11 MOHP Recurrent Yearly Not Yet Due Systems Completion Measurement TOTs completed for all seven provinces for Provincial Training Centers in SA guidelines Comments Action Description Consultations with key stakeholders for development of Nepal Health Sector Strategy 2022-2027 Source DLI# Responsibility Timing Timing Value Status Technical MOHP Recurrent Yearly Not Yet Due Consultations with (i) all 7 provinces; (ii) at least one local government per province; (iii) External Development Completion Measurement Partners towards development of NHSS (2022-2027) 10/25/2021 Page 5 of 13 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Comments Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic Moderate Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and High Moderate Moderate Sustainability Fiduciary High Moderate Moderate Environment and Social Low Low Low Stakeholders Moderate Moderate Moderate Other Moderate Moderate Moderate Overall High Substantial Substantial Results PDO Indicators by Objectives / Outcomes The PDO is to improve efficiency in public resource management systems of the health sector in Nepal IN01041763 ►Percentage reduction of less than minimum stocks (understock) of tracer health commodities in sub-provincial medical stores (DLI 5) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DLR 5.3: 35% 58.94% reduction in reduction in 42.8% reduction in understock of tracer understock of tracer understock of tracer health commodities in health commodities in health commodities in Year 5 over the Year 6 over the Baseline to be established Year 4 over the baseline baseline established for Value baseline established in Year 3 established for the sub- the sub-provincial for the sub-provincial provincial (district) stores (district) stores through (district) stores through through the eLMIS for the eLMIS for two the eLMIS for two two Provinces Provinces of Lumbini Provinces. and Karnali Date 15-Jul-2019 15-Nov-2020 15-Sep-2021 16-Jul-2022 The list of “tracer health commodities” procured by the MD will be jointly agreed by the government and Comments partners. The required minimum stock of tracer health commodities will be agreed and defined in the baseline for Year 3. Any stock below the minimum required level will be labelled as "understock". IN01041764 10/25/2021 Page 6 of 13 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) ►Percentage of the MoHP’s annual spending captured by the TABUCS/CGAS. (DLI 8) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DLR 8.6: 95% of 91.2% of MoHP spending 97.96% of MoHP MoHP spending in Value 70% in Year 4 captured by spending in Year 4 Year 6 captured by TABUCS captured by TABUCS TABUCS/CGAS Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 16-Jul-2022 Comments Audited spending units to respond to the OAG’s primary audit queries within 35 days of receiving the report. IN01041765 ►Health facilities reporting annual disaggregated data using District Health Information System (DHIS 2) in a timely manner. (DLI 10) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target HMIS/DHIS 2 shows DLR 10.6 HMIS/DHIS HMIS/DHIS 2 shows timely reporting from at 2 shows timely timely reporting from at least 68.71% of public reporting from at least Value 0% least 65.9% of public health facilities in Year 70% of public health health facilities in Year 4 5 facilities in Year 6 Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 16-Jul-2022 Comments Data disaggregated by geography, gender, and ethnicity reported by facilities using DHIS 2 Intermediate Results Indicators by Results Areas 1. Improved Public Procurement IN01041791 ►Percentage of contracts managed by the MD through the PPMO’s online procurement portal (DLI 1) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target No contract is through 99.14% of value of total DLR 1.7: 95% of value 99.48% of value of total online e-procurement contracts managed by of total contracts contracts managed by Value developed by the Public MD done through online managed by MD done MD done through online Procurement Management e-procurement of Year through online e- e-procurement of Year 4 Office (PPMO) 5 procurement of Year 6 Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 16-Jul-2022 Comments IN01041793 ►Establishment and functioning of web-based grievance redressal mechanism (DLI 2) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DLR 2.6: MoHP has MOHP has made MOHP has made made available on its available an annual available an annual Web-based Grievance website an annual report on the website of report on the website of Value Redressal Mechanism not report on the status of Management Division Management Division established grievances received in providing status of providing status of Year 6 grievances registered grievances registered Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 16-Jul-2022 10/25/2021 Page 7 of 13 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Grievance Redressal Mechanism will track complaints and responses related to procurement and supply Comments chain management. IN01041796 ►Percentage of procurements done by Management Division (MD) using standard specifications (DLI 3) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DLR 3.7a For Year 6 procurement, 95% of 100% of MD awarded health commodities 100% of MD awarded contract value for procured by MD, is contract value for Health Health Commodities based on the use of Commodities is based on and Health Equipment standard specifications the use of standard is based on the use of DLR 3.7b For Year 6 Procurement not based on specification. The standard specification. Value procurement, 80% of standard specifications specification available at The specification equipment procured by MD website matches with available at MD website MD is based on the the standard specification matches with the use of standard mentioned in the bidding standard specification specifications document. mentioned in the bidding document. Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 16-Jul-2022 All procurements done by Management Division will be tracked. Standard specifications are as defined by Comments MoHP and publicly disclosed IN01041797 ►Central medical stores and medical stores of Provinces report through eLMIS (DLI 4) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DLR 4.5: eLMIS information for The eLMIS information The eLMIS information program Year 6 is for program Year 5 is for program Year 4 is available from central available from central available from central and provincial Value eLMIS not in place and all the provincial and all the provincial (including sub- (including sub- (including sub-provincial) provincial) stores of provincial) stores of stores of Province Provinces. Province Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 16-Jul-2022 Medical stores are the public warehouses for storing drugs. eLMIS is the real time online logistic Comments management information system which provides information on stocks of drugs and has various functionalities as defined in the verification protocol matrix. IN01041798 ►Percentage improvement in EVM score over 2014 baseline. (DLI 6) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DLR 6.2a Average EVM Score of 70% (based on a survey Average EVM Score of NA-survey suspended Average EVM Score of conducted in 2019 or Value 64%, with two attributes due to COVID-19 82%, with six attributes later) DLR 6.2b Any achieving 80% lockdown achieving 80% four (4) attributes in EVM Score achieving at least 80% Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 16-Jul-2022 Comments EVM is a standard score consisting of nine parameters to determine the management and quality of vaccine management in a country at the central, regional, and service delivery levels 10/25/2021 Page 8 of 13 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) 2. Improved Financial Management IN01041792 ►Percentage of the MoHP spending entities submitting annual plan and budget using eAWPB. (DLI 7) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DLR 7.6a eAWPB used in Year 6 for planning and budget submission by MoHP and all its departments, divisions eAWPB has been used eAWPB has been used and centers in Year 4 for planning in Year 5 for planning DLR 7.6b eAWPB Not all spending units and budget submission and budget submission used in Year 6 for and Value submit their annual plan by the MoHP and its all by the MoHP and its all 95% of remaining and budget using eAWPB departments, divisions, departments, divisions, spending units centers and spending centers and spending (excluding units units. units. included under DLR 7.6a) under MoHP Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 16-Jul-2022 Comments eAWPB is a software at MoHP used for annual workplan and budgeting. IN01041794 ►Percentage of audited spending units responding to the OAG’s primary audit queries within 35 days. (DLI 9) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DLR 9.6 80% of spending units 97.4% of the cost centers 91.6% of the cost Percentage as derived reporting to the MoHP responded to the OAG’s centers responded to Value from MoHP inventory of respond to primary audit queries within 35 the OAG’s audit queries responses in Year 1 audit queries within days. within 35 days. mandated 35 days Date 17-Jul-2017 15-Nov-2020 15-Sep-2021 16-Jul-2022 OAG sends primary audit queries to the respective audited spending units and gives them 35 days to Comments respond. 3. Improved Reporting and Information Sharing for Enhanced Accountability and Transparency IN01041795 ►MoHP to provide guidance and support to the subnational governments on citizen engagement mechanism (DLI 11) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target MoHP has updated the DLR 11.6: MoHP No formal guidelines for MoHP has provided guideline on social audit provided on-site citizen feedback orientation to all mechanism. However, support to at least Value mechanisms in place for provinces on new social sub-national three (3) Local Provinces and/or Local accountability dissemination of Governments each in Governments framework guideline has not been at least four Provinces 10/25/2021 Page 9 of 13 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) possible due to COVID in conducting social 19 pandemic audits Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 16-Jul-2022 Comments Social audit is the most frequently used citizen engagement mechanism in the health sector. Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 Percentage of contracts managed by the MD through the PPMO’s online procurement portal (DLI 1) (Intermediate Outcome, 19,597,452.00, 66%) July 16, 2021 - July Baseline Actual (Previous) Actual (Current) 16, 2022 99.48% of values of total DLR 1.7: 95% of 99.14% of values of total No contract is through contracts managed by value of total contracts managed by MD online e-procurement MD is done through contracts managed is done through online e- Value developed by the Public online e-procurement of by MD done through procurement of Year 5. Procurement Management year 4. online e- Office (PPMO) procurement of Year 6 Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 -- Year 1-4 results achieved Comments ►DLI 2 Establishment and functioning of web-based grievance redressal mechanism (DLI 2) (Intermediate Outcome, 13,064,968.00, 69%) July 16, 2021 - July Baseline Actual (Previous) Actual (Current) 16, 2022 DLR 2.6: MoHP has Annual report on status Annual report on status of made available on Web-based Grievance of grievances is made grievances is made its website an Value Redressal Mechanism not available on the available on the annual report on the established Management Divisions Management Divisions status of grievances website for the public use website for the public use received in Year 6 Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 -- Year 1-4 results achieved Comments ►DLI 3 Percentage of procurements done by Management Division (MD) using standard specifications (DLI 3) (Intermediate Outcome, 16,500,022.00, 64%) July 16, 2021 - July Baseline Actual (Previous) Actual (Current) 16, 2022 100% of MD awarded DLR 3.7 a: For Year 100% of MD awarded contract value for Health 6 procurement, 95% contract value for Health Commodities are based of health Commodities and Health on the use of standard commodities Equipment are based on Procurement not based on specification. The procured by MD, is Value the use of standard standard specifications specification available at based on the use of specification. The MD website matches with standard specification available at the standard specification specificationsDLR MD website matches with mentioned in the bidding 3.7 b: For Year 6 the standard specification document. procurement, 80% 10/25/2021 Page 10 of 13 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) mentioned in the bidding of equipment document. procured by MD is based on the use of standard specifications Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 -- DLR 3.1 MoHP endorses standard specifications for basic package of drugs to be procured by LMD- Achieved DLR 3.2 For Year 2 procurement, 70% of procurement of basic package of free drugs based on the use of standard specifications- 100% Comments DLR 3.3 Verify that the MoHP, through a public notification, has endorsed standard specifications for essential equipment procured by the LMD- off track Year 1-4 results achieved ►DLI 4 Central medical stores and medical stores of Provinces report through eLMIS (DLI 4) (Intermediate Outcome, 28,500,057.00, 40%) July 16, 2021 - July Baseline Actual (Previous) Actual (Current) 16, 2022 DLR 4.5: eLMIS eLMIS information for eLMIS information for information for program Year 4 is program Year 5 is program Year 6 is available from central available from central and available from Value eLMIS not in place and all the provincial all the provincial (including central and (including sub-provincial) sub-provincial) stores of provincial (including stores of Province. Province. sub-provincial) stores of Provinces. Date 13-Jan-2017 01-Jun-2020 15-Sep-2021 -- Years 2-4 results achieved Comments ►DLI 5 Percentage reduction of less than minimum stocks (understock) of tracer health commodities in sub-provincial medical stores (DLI 5) (Outcome, 18,644,042.00, 22%) July 16, 2021 - July Baseline Actual (Previous) Actual (Current) 16, 2022 DLR 5.3: 35% reduction in 43.67% and 41.65% 54.44% and 59.74% understock of tracer reduction in the reduction in the health commodities understock of the tracer understock of the tracer in Year 6 over the Baseline to be established health commodities from Value health commodities from baseline established in Year 3 the baseline to Year 4 in the baseline to Year 5 in for the sub- the provinces 5 and the Lumbini and Karnali provincial (district) Karnali Province Province respectively. stores through the respectively. eLMIS for two Provinces. Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 -- Years 4 result achieved Comments ►DLI 6 Percentage improvement in EVM score over 2014 baseline. (DLI 6) (Intermediate Outcome, 3,413,620.00, 59%) July 16, 2021 - July Baseline Actual (Previous) Actual (Current) 16, 2022 10/25/2021 Page 11 of 13 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Average EVM Score of NA- pending EVM survey Average EVM score of Value 64%, with two attributes results. likely to happen 82% with six attributes -- achieving 80% next FY scoring over 80% Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 -- Average EVM score of 82% with 4 attributes in EVM score achieving 80%. (target achieved). Comments ►DLI 7 Percentage of the MoHP spending entities submitting annual plan and budget using eAWPB. (DLI 7) (Intermediate Outcome, 20,049,026.00, 0%) July 16, 2021 - July Baseline Actual (Previous) Actual (Current) 16, 2022 DLR 7.6a: eAWPB used in Year 6 for planning and budget submission by eAWPB has been used eAWPB has been used in MoHP and all its in Year 4 for planning Year 4 for planning and departments, Not all spending units and budget submission budget submission by the divisions and Value submit their annual plan by the MoHP and its all MoHP and its all centers DLR 7.6b: and budget using eAWPB departments, divisions, departments, divisions, eAWPB used in centers and spending centers and spending Year 6 for and 95% units. units. of remaining spending units (excluding units included under DLR 7.6a) under MoHP Date 13-Jan-2017 15-Nov-2020 15-Nov-2020 -- Years 1-4 results achieved Comments ►DLI 8 Percentage of the MoHP’s annual spending captured by the TABUCS/CGAS. (DLI 8) (Outcome, 25,957,785.00, 0%) July 16, 2021 - July Baseline Actual (Previous) Actual (Current) 16, 2022 91.16% of the MoHP 91.16% of the MoHP expenditure was expenditure was captured DLR 8.6: 95% of captured through through TABUCS during MoHP spending in Value 70% TABUCS during the FY the FY 2076/77 (between Year 6 captured by 2076/77 (between 17 17 July 2019 to 16 July TABUCS/CGAS July 2019 to 16 July 2020) 2020) Date 13-Jan-2017 15-Nov-2020 15-Nov-2020 -- Years 1-4 results achieved and DLR value for Year 5 revised to US$4,950,000 Comments ►DLI 9 Percentage of audited spending units responding to the OAG’s primary audit queries within 35 days. (DLI 9) (Intermediate Outcome, 21,250,027.00, 58%) July 16, 2021 - July Baseline Actual (Previous) Actual (Current) 16, 2022 Value Percentage as derived from 97.4% of the cost centers 91.6% of the cost centers DLR 9.6: 80% of MoHP inventory of responded to the OAG’s responded to the OAG’s spending units responses in Year 1 audit queries within 35 audit queries within 35 reporting to the days. days. MoHP respond to 10/25/2021 Page 12 of 13 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) primary audit queries within mandated 35 days Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 -- Years 1-4 results achieved Comments ►DLI 10 Health facilities reporting annual disaggregated data using District Health Information System (DHIS 2) in a timely manner. (DLI 10) (Outcome, 27,161,702.00, 55%) July 16, 2021 - July Baseline Actual (Previous) Actual (Current) 16, 2022 DLR 10.6: HMIS/DHIS 2 shows HMIS/DHIS 2 shows HMIS/DHIS 2 shows timely reporting from timely reporting from timely reporting from Value 0% 66.03% of public health 68.71% of public health at least 70% of facilities in Year 4. facilities in Year 5. public health facilities in Year 6 Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 -- Year 1 to 4 targets achieved and disbursed Comments ►DLI 11 MoHP to provide guidance and support to the subnational governments on citizen engagement mechanism (DLI 11) (Intermediate Outcome, 6,976,000.00, 50%) July 16, 2021 - July Baseline Actual (Previous) Actual (Current) 16, 2022 DLR 11.6: MoHP MoHP has updated the provided on-site No formal guidelines for guideline on social audit support to at least MoHP has provided citizen feedback mechanism. However, three (3) Local orientation to all provinces Value mechanisms in place for sub-national Governments each on new social Provinces and/or Local dissemination was not in at least four accountability framework Governments possible due to COVID Provinces in 19 pandemic conducting social audits Date 13-Jan-2017 15-Nov-2020 15-Sep-2021 -- Year 1 and 3 results fully achieved, Year 4 result partially achieved Comments 10/25/2021 Page 13 of 13