The World Bank Report No: ISR4471 Implementation Status & Results Brazil Second Family Health Extension Adaptable Lending (P095626) Public Disclosure Copy Operation Name: Second Family Health Extension Adaptable Lending Project Stage: Implementation Seq.No: 7 Status: ARCHIVED Archive Date: (P095626) Country: Brazil Approval FY: 2008 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Adaptable Program Loan Implementing Agency(ies): Ministry of Health Key Dates Board Approval Date 25-Apr-2008 Original Closing Date 30-Mar-2012 Planned Mid Term Review Date 31-Jul-2012 Last Archived ISR Date 26-Feb-2011 Effectiveness Date 15-Oct-2009 Revised Closing Date 30-Mar-2013 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The objectives of the second phase APL are: (i) increase access to Family Health-based primary care in large, urban municipalities; (ii) raise the technical quality of and patient satisfaction with primary care; and (iii) improve the efficiency and effectiveness of Family Health service providers as well as the broader delivery system. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Expansion and Consolidation of Family Health Care in Municipalities 133450.00 Strengthening State Capacity for Supervision, Monitoring and Technical Support of Family Health 17450.00 Services Strengthening Federal Oversight of the Family Health Program 16000.00 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview The population coverage by PROESF increased rapidly in the initial phase and continues to grow in the second phase, but at a much slower rate (5 percent per annum). From 2009 to 2010, coverage in participating municipalities increased from 36.4% to 38.4% of the population; average coverage is higher among participating municipalities. Though no specific Page 1 of 5 The World Bank Report No: ISR4471 outcome targets were set in the Project Appraisal Document for this second phase of the program, the Ministry of Health established the following goals: (i) a 5% reduction of infant mortality in participating municipalities, and (ii) an increase of 5% in the number of family health visits per capita in these municipalities. The first goal has been achieved--a 22% reduction in 2009, according to data provided by municipalities--and surpasses the target set for phase 3. The second target, which translates into 1.5 consultations per capita per year, was not met; it fell from 1.4 to 1.1 consultations per capita per year. Public Disclosure Copy Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increase of per capita contact with primary care Text Value 1.4 1.1 1.5 providers in participating municipalities. Date 31-Dec-2003 31-Dec-2009 30-Mar-2013 Comments Decrease of infant mortality per 1000 births in Text Value 17.8 13.9 17 participating municipalities. Date 31-Dec-2003 31-Dec-2009 30-Mar-2013 Comments Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of PSF population coverage in Text Value 33% 38.4% 37 participating municipalities (as a group). Date 31-Dec-2006 31-Dec-2009 30-Mar-2013 Comments Ratio of patients with hypertension followed by Text Value 0.23 .49 .35 PSF teams to estimated number of patients w/ hypertension in participating municipalities (as Date 31-Dec-2006 31-Dec-2009 30-Mar-2013 Public Disclosure Copy a group). Comments Percentage of infants < 1 with full vaccination Text Value 71 96.3 85 regimen (DPT-H, polio, measles, tuberculosis) in participating municipalities (as agroup). Date 31-Dec-2006 31-Dec-2009 30-Mar-2013 Comments Page 2 of 5 The World Bank Report No: ISR4471 Indicator Name Core Unit of Measure Baseline Current End Target Percentage of pregnant women attended by Text Value 60% 62.4 70 PSF teams that have 7 or more pre-natal Date 31-Dec-2006 31-Dec-2009 30-Mar-2013 Public Disclosure Copy consultations in participating municipalities (as a group). Comments Percentage of total medical consultations Text Value 10% 6.4 10 referred from PSF to hospital specialty services in participating municipalities (as a group). Date 31-Dec-2006 31-Dec-2009 30-Mar-2013 Comments Percentage of all PSF teams applied quality Text Value 7% 7% 15 evaluation instrument and are ranked according to standard (AMQ system) in Date 31-Dec-2006 31-Dec-2010 30-Mar-2013 participating municipalities (as a group). Comments Percentage of PSF teams in a sample of Text Value NA 56.6 15 municipalities using evidence-based clinical guidelines for hypertension and diabetes Date 31-Dec-2006 31-Dec-2010 30-Mar-2013 (basedon sample survey) in participating Comments municipalities (as a group). Rate of hospital admissions of children <5 for Text Value 24/1000 26 22/1000 ARI in participating municipalities (as a group). Date 31-Dec-2006 31-Dec-2009 30-Mar-2013 Comments Rate of hospital admissions for stroke in Text Value 27/1000 8 26/1000 participating municipalities (as a group). Date 31-Dec-2006 31-Dec-2009 30-Mar-2013 Comments Percentage of municipalities apply quality Text Value 0 9.4% 10 evaluation instrument in the areas of PSF management and coordination (AMQ parts 1 & Date 31-Dec-2006 31-Dec-2010 30-Mar-2013 2) in participating municipalities (as a group). Comments Public Disclosure Copy Percentage of states establish performance Text Value 0 100% of states and 40% states, 25% agreements with at least X% municipalities with 100% of municipalities municipalities <100,000 population in participating states (as Date 31-Dec-2006 31-Dec-2009 30-Mar-2013 a group). Comments Percentage of states with monitoring and Text Value 0 7 (27%) states w/ 50% evaluation plans implemented and evaluated in implemented plans, participating states (as a group) 3 (11%) w/ implemented and evaluated plans Page 3 of 5 The World Bank Report No: ISR4471 Date 31-Dec-2006 31-Dec-2009 30-Mar-2013 Comments Percentage of municipalities with <100,000 Text Value 0 3,8% (1 state) w/ at least 10% of municipalities in 50% Public Disclosure Copy population in X% states participate in quality 10% municipalities of states assessment program (AMQ) - participating Date 31-Dec-2006 31-Dec-2009 30-Mar-2013 states as a group. Comments Establishment, at federal level, of a results- Text Value NA System designed; module System developed and tested. based management system that links project developed and installed financing to states and municipalities. Date 31-Dec-2006 30-Jun-2010 30-Mar-2013 Comments Cost accounting system (at federal level). Text Value NA TR elaborated Study concluded and system developed. Date 31-Dec-2006 30-Jun-2010 30-Mar-2013 Comments Six major research projects on PSF (at least Text Value Not applicable Bids financed and published 3 studies concluded. one on chronic diseases, one on patient with own resources satisfaction, and one on PSF impact on Date 31-Dec-2006 30-Jun-2010 30-Mar-2013 hospital admissions). Comments Impact evaluation. Text Value NA NA Plans, methods and TOR Date 31-Dec-2006 31-Dec-2010 30-Mar-2013 Comments Proficiency test of PSF professionals. Text Value NA Changes suggested Test developed. Date 31-Dec-2006 18-Feb-2011 30-Mar-2013 Comments Inter-municipal cooperation plan implemented Text Value NA Project developed 1 per State (20 states) Public Disclosure Copy in each state to strengthen PSF, specifying activities in three areas: management, Date 31-Dec-2006 30-Jun-2010 30-Mar-2013 coordination, service Provision. Comments Percentage of ESF implement results-based Text Value NA 11 model developed and tested. management system, including the signing of performance contracts. Date 31-Dec-2006 31-Dec-2009 30-Mar-2013 Comments Data on Financial Performance (as of 25-Jul-2011) Page 4 of 5 The World Bank Report No: ISR4471 Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P095626 IBRD-75450 Effective 25-Apr-2008 09-Sep-2009 15-Oct-2009 30-Mar-2013 Public Disclosure Copy Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P095626 IBRD-75450 Effective USD 83.45 83.45 0.00 27.12 56.33 33.00 Disbursement Graph Key Decisions Regarding Implementation The next supervision mission for the project is scheduled for October 2011. Public Disclosure Copy Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Page 5 of 5