The World Bank Implementation Status & Results Report Improving Maternal and Child Health through Integrated Social Services (P123706) Improving Maternal and Child Health through Integrated Social Services (P123706) LATIN AMERICA AND CARIBBEAN | Haiti | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2013 | Seq No: 11 | ARCHIVED on 31-Dec-2018 | ISR35476 | Implementing Agencies: FONDS D'ASSISTANCE ECONOMIQUE ET SOCIALE, Ministry of Public Health and Population, Republic of Haiti, Institut Haïtien de Statistique et d’Informatique Key Dates Key Project Dates Bank Approval Date: 21-May-2013 Effectiveness Date: 20-Apr-2013 Planned Mid Term Review Date: 15-Oct-2018 Actual Mid-Term Review Date: 31-Oct-2018 Original Closing Date: 31-Dec-2018 Revised Closing Date: 31-Dec-2019 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The objective of the proposed Project is to increase the access and use of maternal and child health, nutrition and other social services in the Recipient’s territory. The Project will support services in at least three Departments with a total catchment population of around 1.8 million people, targeting pregnant women,children under five and vulnerable families.Progress on the objectives of the Project will be measured by the following:(i) percent of children under five immunized; (ii) percent of institutional deliveries; (iii) contraceptive prevalence rate; and (iv) decrease in percentage of families categorized as extremely vulnerable. 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) To increase the access and use of maternal and child health services, strengthen cholera control, and improve targeting of social services in the Recipient s territory, with a particular focus on areas affected by Hurricane Matthew. Components Table Name Component 3: Piloting Vulnerability Indicators for More Targeted Social Service Delivery:(Cost $5.00 M) Component 1: Providing Maternal and Child Health, Nutrition and Social Services.:(Cost $92.82 M) Component 2: Strengthening the Stewardship and Management Capacity of Government.:(Cost $11.46 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions 12/31/2018 Page 1 of 8 The World Bank Implementation Status & Results Report Improving Maternal and Child Health through Integrated Social Services (P123706) The project was approved by the Board on 21 May 2013. Project activities fall under four key streams: (i) Results-Based Financing (RBF) to Promote Maternal and Child Health; (ii) Cholera Program; (iii) Social Protection activities (linked to the social registry); and (iv) activities related to a pilot census. Activities aimed at strengthening the stewardship and management capacity of government are embedded in these streams. The Project is progressing well towards achieving the targets for its indicators. Overall, most of the Project Indicators' end targets (for PDO and Intermediate Indicators) have been achieved or exceeded. Implementation has overall been proceeding well, and disbursements under the Project have accelerated. For the period January 1st – November 23, 2018, the cholera case fatality ratio indicator is 1.12% which is above the 1% target but the incidence rate has dropped to 0.29 cases/1000 people (3,644 suspected cases and 41 deaths) from 1.02 cases for the same period in 2017 (12,800 suspected cases and 146 deaths). These indicators at are at a historically low point since the beginning of the epidemic, reflecting the sustained efforts under this Project in the fight against cholera. 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 -- Substantial Substantial Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Substantial Substantial Fiduciary -- Substantial Substantial Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes To increase access and use of mater. and child health, nutrition and other Soc Serv in recipient ter IN00607186 ►Children under five immunized (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 46.22 44.22 44.22 49.00 Date 31-Dec-2012 30-Apr-2017 30-Apr-2017 31-Dec-2019 IN00607188 ►Institutional deliveries (Percentage, Custom) 12/31/2018 Page 2 of 8 The World Bank Implementation Status & Results Report Improving Maternal and Child Health through Integrated Social Services (P123706) Baseline Actual (Previous) Actual (Current) End Target Value 21.26 37.62 37.62 24.00 Date 31-Dec-2012 30-Apr-2017 30-Apr-2017 31-Dec-2019 IN00607190 ►Contraceptive prevalence rate (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 23.37 33.39 33.39 26.00 Date 31-Dec-2012 30-Apr-2017 30-Apr-2017 31-Dec-2019 IN00607192 ►Cholera Case Fatality Rate (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.89 -- 1.12 0.99 Date 31-Dec-2015 -- 24-Nov-2018 31-Dec-2019 While the case-fatality ratio increased, the incidence rate has dropped to 0.29 cases/1000 people from 1 January to 23 November 2018 (3,644 suspected cases and 41 deaths) from 1.02 cases for the same Comments: period in 2017 (12,800 suspected cases and 146 deaths). IN00607195 ►Pilot census carried out in four departments (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No -- Yes Yes Date 31-Dec-2015 -- 31-Aug-2018 31-Dec-2019 From June to August 2018, the IHSI implemented the pilot of their upcoming Fifth Housing and Population Census scheduled for spring 2019. The pilot was implemented in four departments (Ouest, Artibonite, Comments: Nord Ouest, and Grand’Anse). Intermediate Results Indicators by Components Component 1: Providing Maternal and Child Health, Nutrition and Social Services. IN00656125 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 862,630.00 881,000.00 Date 31-Jan-2013 -- 31-Dec-2017 31-Dec-2019 IN00656146 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target 12/31/2018 Page 3 of 8 The World Bank Implementation Status & Results Report Improving Maternal and Child Health through Integrated Social Services (P123706) Value 0.00 -- 640,985.00 660,000.00 Date 01-Jan-2013 -- 31-Dec-2017 31-Dec-2019 IN00656147 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 201,949.00 200,000.00 Date 01-Jan-2013 -- 31-Dec-2017 31-Dec-2019 IN00656148 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 19,696.00 21,000.00 Date 01-Jan-2013 -- 31-Dec-2017 31-Dec-2019 IN00607187 ►Children 6-59 months old receiving Vitamin A supplementation (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 34,854.00 58,698.00 26,200.00 Date 31-Dec-2012 31-Dec-2017 30-Jun-2018 31-Dec-2019 Based on comparisons of quarterly totals. Comments: IN00607189 ►Children aged under 12 months that are completely vaccinated at health facilities under the RBF program (percentage increase over baseline). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 0% by definition for Value baseline quarter (Q3 of -- 51% 13% 2016) Date 30-Sep-2016 -- 30-Jun-2018 31-Dec-2019 Based on comparisons of quarterly totals. Comments: IN00607191 ►Births at health facilities under the RBF program (percentage increase over baseline). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 0% by definition for Value baseline quarter (Q3 of -- 13% 10% 2016) Date 30-Sep-2016 -- 31-Dec-2017 31-Dec-2019 Based on comparisons of quarterly totals. Comments: IN00607193 ►Utilization of modern contraceptives via health facilities under the RBF program (percentage increase over baseline). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/31/2018 Page 4 of 8 The World Bank Implementation Status & Results Report Improving Maternal and Child Health through Integrated Social Services (P123706) 0% by definition for Value baseline quarter (Q3 of -- 13% 15% 2016) Date 30-Sep-2016 -- 30-Jun-2018 31-Dec-2019 Based on comparisons of quarterly totals. Comments: IN00607194 ►Children aged between 6 and 59 months receiving nutritional screening and follow up under the RBF program (percentage increase over baseline). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 0% by definition for Value baseline quarter (Q3 of -- 55% 12% 2016) Date 30-Sep-2016 -- 30-Jun-2018 31-Dec-2019 Based on comparisons of quarterly totals. Comments: IN00607196 ►Contracted service providers achieving the minimum quality score (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 71.00 91.00 45.00 Date 31-Dec-2012 30-Jun-2015 30-Jun-2018 31-Dec-2019 Includes the sites having achieved quality score more than 60%. Comments: IN00607197 ►Contracted health providers supervised at least quarterly (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 95.00 Date 31-Dec-2012 30-Sep-2017 30-Sep-2018 31-Dec-2019 IN00607198 ►Health personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 530.00 530.00 250.00 Date 31-Dec-2012 31-Oct-2016 31-Oct-2016 31-Dec-2019 IN00607199 ►Providers using the contracting model (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 39.00 39.00 50.00 Date 31-Dec-2012 31-May-2018 31-May-2018 31-Dec-2019 IN00607200 ►Percentage of cholera alerts and outbreaks investigated and acted on by mobile rapid response teams (EMIRAs) within 48 hours of onset (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/31/2018 Page 5 of 8 The World Bank Implementation Status & Results Report Improving Maternal and Child Health through Integrated Social Services (P123706) Value 7.00 -- 76.50 60.00 Date 31-Dec-2014 -- 30-Sep-2018 31-Dec-2019 From Oct-2017 to Sept 2018 Comments: IN00607201 ►Number of water and sanitation interventions supported at health facility and community levels (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 115.00 65.00 Date 31-Dec-2012 -- 30-Sep-2018 31-Dec-2019 IN00607202 ►Percentage of health facilities assessed with adequate stocks of cholera supplies, in Departments affected by the Hurricane (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 100.00 90.00 Date 15-Jun-2017 -- 31-Oct-2018 31-Dec-2019 IN00607203 ►Number of health facilities rehabilitated and fully functioning, in Departments affected by Hurricane (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 22.00 40.00 Date 31-Dec-2016 -- 31-Oct-2017 31-Dec-2019 Rehabilitation of 40 sites is ongoing in Nippes, Sud, Grande Anse, and Nord-Ouest departments. TO respond to the immediate emergency after Hurricane Matthew (Oct 2016) and before the Additional Comments: Financing was effective, the current Project financed critical rehabilitation of 22 sites under the RBF program in the South Department (reported here). IN00607204 ►Number of refrigerators restored and fully functional as part of the vaccine cold chain in the Hurricane-affected Departments (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 90.00 84.00 Date 31-Dec-2016 -- 30-Nov-2018 31-Dec-2019 In addition to 90 solar-powered refrigerator for the cold chain, 17 additional units were financed and installed in all the departments to strengthen the capacity of the National Laboratory for Public Helath Comments: (LNSP) to collect and analyze samples of patients suspected of cholera and allow a more targeted community response for confirmed cases. IN00607207 ►Citizen Engagement Indicator: % of facilities under RBF that developed an action plan(s) based on the results of community satisfaction surveys (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 31-Dec-2016 -- 30-Nov-2018 31-Dec-2019 12/31/2018 Page 6 of 8 The World Bank Implementation Status & Results Report Improving Maternal and Child Health through Integrated Social Services (P123706) Due to delays in project effectiveness, the strengthening of CE mechanisms has been delayed. How ever, the Ministry has revised the CE tools and feedback mechanisms should be piloted soon. Comments: . Component 3: Piloting Vulnerability Indicators for More Targeted Social Service Delivery IN00607205 ►Preliminary calculation by the IHSI of vulnerability clusters in the four pilot departments (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No -- Yes Yes Date 31-Dec-2015 -- 30-Sep-2018 31-Dec-2019 This is expected to be done later this calendar year. Comments: Component 2: Strengthening the Stewardship and Management Capacity of Government. IN00607206 ►Steering committee to oversee registry identified or created and operational (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No -- No Yes Date 31-Dec-2015 -- 30-Nov-2018 31-Dec-2019 IN00607208 ►Number of households included in the social registry (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 300,000.00 Date 31-Dec-2015 -- 31-Oct-2018 31-Dec-2019 Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P123706 IDA-D2030 Effective USD 25.00 25.00 0.00 8.49 17.07 33% P123706 IDA-H8640 Effective USD 70.00 70.00 0.00 55.93 9.47 86% P123706 TF-13431 Closed USD 0.85 0.82 0.03 0.82 0.00 100% P123706 TF-14474 Effective USD 20.00 20.00 0.00 6.70 13.30 34% 12/31/2018 Page 7 of 8 The World Bank Implementation Status & Results Report Improving Maternal and Child Health through Integrated Social Services (P123706) Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P123706 IDA-D2030 Effective 14-Jun-2017 29-Jun-2017 24-Jan-2018 31-Dec-2019 31-Dec-2019 P123706 IDA-H8640 Effective 21-May-2013 14-Jun-2013 12-Sep-2013 31-Dec-2018 31-Dec-2019 P123706 TF-13431 Closed 20-Apr-2013 20-Apr-2013 20-Apr-2013 31-Dec-2013 30-Jun-2014 P123706 TF-14474 Effective 14-Jun-2013 14-Jun-2013 15-Sep-2014 31-Dec-2018 31-Dec-2019 Cumulative Disbursements Restructuring History Level 2 Approved on 29-Mar-2017 Related Project(s) P163313-Additional Financing for the Improving Maternal and Child Health Through Integrated Social Services Project 12/31/2018 Page 8 of 8