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: 14 | ARCHIVED on 26-Jun-2020 | ISR42065 | Implementing Agencies: Ministry of Health & Social Protection Project Coordination Group, Republic of Tajikistan, Ministry of Health & Social Protection 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-2022 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 $19.83 M) Component 2: Primary Health Care Strengthening:(Cost $18.48 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 Unsatisfactory Overall Implementation Progress (IP) Satisfactory Moderately Unsatisfactory Overall Risk Rating Substantial High Implementation Status and Key Decisions During the period covered by this ISR (early-December 2019 through early-June 2020) the activities carried out were largely in preparation for activities that will be financed under the Second Additional Financing, which still awaits signing of the Financing Agreement and ratification. Some project activities have been hindered as a result of the COVID-19 pandemic; all female Technical Support Group staff were on home-based work arrangement at the time of this mission, and activities involving face-to-face interaction are proceeding at a slower pace than planned. 6/26/2020 Page 1 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) Performance-Based Financing (PBF) has been on hold in the ten districts where PBF has been implemented. In anticipation of implementing the revised PBF program, good progress has been made in finalizing the PBF, PBF Verification and Household Engagement manuals. Facility site surveys are to be carried out by the Capital Construction Department of the Ministry of Health and Social Protection (MoHSP) in six new project- supported districts participating in the PBF scheme to establish physical infrastructure needs. The MoHSP is preparing a list of selection criteria for the site survey, for review and no objection by the WB, before proceeding with this survey. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial High Macroeconomic -- Substantial High Sector Strategies and Policies -- Moderate Moderate Technical Design of Project or Program -- Substantial Substantial Institutional Capacity for Implementation and -- Moderate High Sustainability Fiduciary -- Substantial Substantial Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- -- Substantial Overall -- Substantial High Results PDO Indicators by Objectives / Outcomes Coverage of basic Primary Health Care (PHC) services in selected districts IN00851253 ►Mothers receiving timely postnatal counselling in existing districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 90.00 90.00 90.00 93.00 Date 11-Oct-2019 11-Oct-2019 11-Oct-2019 31-May-2022 Note: the end target is for AF-2, which is not yet effective. This target takes into account the expansion into new Project districts, which will not be as well-performing as existing Project districts initially. The Comments: target under AF-1 was met only in Sogd region, according to DHS data. However, project and impact evaluation data showed improvements also in Khatlon and RRS regions. IN00851255 6/26/2020 Page 2 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) Mothers receiving timely postnatal counselling in new districts (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 60.00 60.00 65.00 IN00851286 ►Number of mothers counselled on nutrition (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 182,452.00 182,452.00 182,452.00 230,000.00 Date 11-Oct-2019 11-Oct-2019 11-Oct-2019 31-May-2022 Note: this is a new indicator for AF-2, which is not yet effective; actual data is from baseline. Comments: Quality of basic Primary Health Care (PHC) services in selected districts IN00851252 ►Average Health Facility Quality of Care Score in existing project districts (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 60% (average among 10 83% (average among 91% (average among 10 91% (average among participating districts, 10 participating participating districts, 10 participating RHCs) districts, RHCs), 73% RHCs) districts, RHCs) Value 50.6% (average among (average among 10 89% (average among 10 90% (average among 10 participating districts, participating districts, participating districts, 10 participating HHs) HHs) HHs) districts, HHs) Date 11-Oct-2019 27-May-2019 25-Nov-2019 31-May-2022 Note: the end target is for AF-2, which is not yet effective. This target takes into account the expansion into new Project districts, which will not be as well-performing as existing Project districts initially. The Comments: current end-target (83.3% for both RHCs and HHs) under AF-1 has been exceeded. IN00851254 Average Health Facility Quality of Care Score in new project districts (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Rural health center 55 Rural health center 65 Rural health center 55 Rural health center 55 percent percent Value percent percent Health House 50 Health House 55 Health House 50 percent Health House 50 percent percent percent Intermediate Results Indicators by Components Component 1: Performance Based Financing IN00851287 ►Number of eligible health facilities in which PBF is initiated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 449.00 449.00 450.00 700.00 6/26/2020 Page 3 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) Date 11-Oct-2019 11-Oct-2019 25-Nov-2019 31-May-2022 Note: the end target is for AF-2, which is not yet effective. The current end-target (413) under AF-1 has Comments: been exceeded. IN00851290 ►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 27-May-2019 25-Nov-2019 31-May-2022 Note: the end target is for AF-2, which is not yet effective. The current end-target (100%) under AF-1 has Comments: been achieved. IN00851292 ►Number of independent verification visits completed per schedule (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 10.00 10.00 14.00 Date 11-Oct-2019 11-Oct-2019 25-Nov-2019 31-May-2022 Note: the end target is for AF-2, which is not yet effective. The current end-target (9) under AF-1 has Comments: been exceeded. IN00851293 ►Percentage of hypertension patient charts with treatment according to protocol in existing districts (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 94.4%. 96.3%. 80% Value 85% Date 11-Oct-2019 11-Oct-2019 25-Nov-2019 31-May-2022 Note: the end target is for AF-2, which is not yet effective. This target takes into account the expansion into new Project districts, which will not be as well-performing as existing Project districts initially. The Comments: current end-target (60%) under AF-1 has been exceeded. IN00851294 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% 20% 20% 30% IN00851295 ►Number of citizen scorecard exercises/sessions conducted in the project districts. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 288.00 288.00 360.00 450.00 6/26/2020 Page 4 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) Date 22-Oct-2019 27-May-2019 25-Nov-2019 31-Dec-2019 Note: the end target is for AF-2, which is not yet effective. The current end-target (232) under AF-1 has Comments: been exceeded. IN00851296 Average proportion of women attending citizen scorecard exercises (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 IN00851297 ►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 11-Oct-2019 11-Oct-2019 31-May-2022 Note: this is a new indicator under AF-2, which is not yet effective. Comments: IN00851298 ►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 1,250,831.00 1,250,831.00 1,350,831.00 Date 11-Oct-2019 11-Oct-2019 11-Oct-2019 31-May-2022 Note: the end target is for AF-2, which is not yet effective. The end-target under AF-1 was substantially Comments: exceeded. IN00851299 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 1,166,908.00 1,166,908.00 1,216,908.00 IN00851300 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 163,699.00 163,699.00 163,699.00 180,000.00 Date 11-Oct-2019 11-Oct-2019 11-Oct-2019 31-May-2022 IN00851301 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 939,107.00 939,107.00 939,107.00 1,000,000.00 Date 11-Oct-2019 11-Oct-2019 11-Oct-2019 31-May-2022 6/26/2020 Page 5 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) IN00851302 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 148,025.00 148,025.00 100,000.00 Date 01-Oct-2013 27-May-2019 27-May-2019 31-Dec-2019 IN00851303 ►Percentage of PBF facilities completing household engagement exercise (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 11-Oct-2019 11-Oct-2019 11-Oct-2019 31-May-2022 Note: this is a new indicator under AF-2, which is not yet effective. Comments: Component 2: Primary Health Care Strengthening IN00851288 ►Health personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10,289.00 10,289.00 10,607.00 11,289.00 Date 11-Oct-2019 11-Oct-2019 25-Nov-2019 31-May-2022 Note: the end target is for AF-2, which is not yet effective. The current end-target (7,957) under AF-1 has Comments: been exceeded. IN00851291 ►Health facilities rehabilitated and/or equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 403.00 403.00 417.00 470.00 Date 11-Oct-2019 11-Oct-2019 25-Nov-2019 31-May-2022 Note: the end target is for AF-2, which is not yet effective. The current end-target (388) under AF-1 has Comments: been exceeded. Component 3: Project Management, Coordination, and Monitoring & Evaluation IN00851289 ►Number of new project districts in which PBF MIS is operational (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 10.00 10.00 6.00 Date 11-Oct-2019 11-Oct-2019 25-Nov-2019 31-May-2022 6/26/2020 Page 6 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) Note: the end target is for AF-2, which is not yet effective. The current end-target (10) under AF-1 has Comments: been achieved. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) 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 Effective USD 4.50 4.50 0.00 4.63 0.00 100% Not P126130 IDA-D5470 USD 10.00 10.00 0.00 0.00 10.07 0% Effective 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% 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 Effective 22-Jun-2015 07-Aug-2015 04-Dec-2015 31-Dec-2019 30-Sep-2020 Not P126130 IDA-D5470 18-Dec-2019 -- -- 30-Jun-2022 30-Jun-2022 Effective 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 Cumulative Disbursements 6/26/2020 Page 7 of 8 The World Bank Implementation Status & Results Report Tajikistan Health Services Improvement Project (HSIP) (P126130) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History Level 2 Approved on 08-Aug-2018 ,Level 2 Approved on 12-Sep-2019 Related Project(s) P153975-Additional Financing to TJ Health Services Improvement Project ,P170358-Second Additional Financing to the Tajikistan Health Services Improvement Project 6/26/2020 Page 8 of 8