Public Disclosure Copy The World Bank Implementation Status & Results Report CF-Health System Support Project (P119815) CF-Health System Support Project (P119815) AFRICA | Central African Republic | Health, Nutrition & Population Global Practice | IBRD/IDA | Specific Investment Loan | FY 2012 | Seq No: 7 | ARCHIVED on 27-Aug-2015 | ISR20501 | Implementing Agencies: Key Dates Key Project Dates Board Approval date:17-May-2012 Effectiveness Date:28-Oct-2012 Planned Mid Term Review Date:31-Dec-2015 Actual Mid-Term Review Date:-- Original Closing Date:31-Mar-2018 Revised Closing Date:31-Mar-2019 Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objective of this proposed operation is to increase utilization and improve the quality of maternal and childhealthservices in targeted rural areas of Central African Republic. 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)PHRPDODEL The revised project development objectives are to: (a) increase utilization and improve the quality of maternal and child health services in targeted rural areas the Recipient’s territory; and (b) provide emergency health services to the general population. Components Name Component 1: Improvement of Health Facilities Performance Through Performance-Based Contracting and Performance-Based Financing:(Cost $20.60 M) Component 2: Strengthening of the Capacity of the Recipient’s Ministry of Health and Population:(Cost $5.60 M) Component 3: Emergency health services:(Cost $14.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Satisfactory Overall Implementation Progress (IP)  Satisfactory  Moderately Satisfactory Overall Risk Rating  --  Substantial 9/2/2015 Page 1 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report CF-Health System Support Project (P119815) Implementation Status and Key Decisions The Additional Financing, which reintroduces IDA financing of US$12 million for implementation of Performance-Based Financing (PBF) (alongside the remaining US$9 million from the HRITF), was approved by the World Bank Board of Executive Directors on May 22, 2015. The project was declared effective on August 11, 2015. For technical aspects, senior PBF experts are updating and validating the national PBF Manual, and conducting a 2-week training course on PBF with all key stakeholders involved in PBF in the country. Performance Purchasing Agencies are being recruited. Positive discussions are ongoing with financial and technical partners relative to their participation in PBF in CAR. The Emergency component (Component 3 of the project) is being implemented as planned and going well. The contract with UNICEF was completed and closed in May 2015 as all planned activities were implemented within the original duration of the contract. Agreements with WHO and UNFPA were extended to December 31, 2015 to allow for more time to complete ongoing activities. A support of US$$500,000 to the Ebola preparedness program is being sought from development partners. Due to the significant delays in implementation in 2013-2014 due to the crisis, the project’s mid-term review is being postponed to allow for the emergency component to be completed and PBF implementation to begin. As such, a full evaluation of the results of the emergency component can be completed at the time of the MTR, as well as an in-depth assessment of the PBF intervention in its initial stages (or just prior to launching). Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  --  High Macroeconomic  --  --  Substantial Sector Strategies and Policies  --  --  High Technical Design of Project or Program  --  --  Moderate Institutional Capacity for Implementation and Sustainability  --  --  High Fiduciary  --  --  Substantial Environment and Social  --  --  Low Stakeholders  --  --  Moderate Other  --  --  -- Overall  --  --  Substantial 9/2/2015 Page 2 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report CF-Health System Support Project (P119815) Results Project Development Objective Indicators PHINDPDOTBL  People with access to a basic package of health, nutrition, or reproductive health services (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 400000.00 593287.00 727843.00 1000000.00 Date 28-Sep-2012 01-Feb-2015 01-Jul-2015 31-Mar-2019 Comments Source: Health facility montly HMIS reports, UN Agency quarterly reports, Ministry of Health quarterly summary report PHINDPDOTBL  Children immunized (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 31360.00 32625.00 41112.00 40000.00 Date 28-Sep-2012 01-Feb-2015 01-Jul-2015 31-Mar-2019 Comments Source: Health facility montly HMIS reports, UN Agency quarterly reports, Ministry of Health quarterly summary report PHINDPDOTBL  Number of births attended by trained personnel in health facility in targeted areas (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 26500.00 15675.00 22647.00 30000.00 Date 28-Sep-2012 01-Feb-2015 01-Jul-2015 31-Mar-2019 Comments Source: Health facility montly HMIS reports, UN Agency quarterly reports, Ministry of Health quarterly summary report PHINDPDOTBL  Number of women victims of violence supported by social and medical health providers (Number, Custom) 9/2/2015 Page 3 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report CF-Health System Support Project (P119815) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2062.00 2492.00 2500.00 Date 04-Mar-2014 01-Feb-2015 01-Jul-2015 31-Mar-2019 Comments Source: Health facility montly HMIS reports, UN Agency quarterly reports, Ministry of Health quarterly summary report PHINDPDOTBL  Direct Project beneficiaries, (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 622822.00 794031.00 1072500.00 Date 28-Sep-2012 01-Feb-2015 01-Jul-2015 31-Mar-2019 Comments Source: Health facility montly HMIS reports, UN Agency quarterly reports, Ministry of Health quarterly summary report PHINDPDOTBL  Of which female (beneficiaries) (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 301805.00 364651.00 536250.00 PHINDPDOTBL  Average score of the quality of care checklist (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 35.00 Date 01-Feb-2015 -- 01-Jul-2015 31-Mar-2019 Overall Comments 9/2/2015 Page 4 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report CF-Health System Support Project (P119815) Intermediate Results Indicators PHINDIRITBL  Number of HIV+ pregnant women receiving PMTCT care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1049.00 1826.00 2528.00 3500.00 Date 14-Feb-2014 01-Feb-2015 01-Jul-2015 31-Mar-2019 Comments Source: Health facility montly HMIS reports, UN Agency quarterly reports, Ministry of Health quarterly summary report PHINDIRITBL  Number of mothers in the project areas who received two doses of intermittent preventive treatment for malaria during last pregnancy (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1312.00 13588.00 21631.00 40000.00 Date 28-Sep-2012 16-May-2014 01-Jul-2014 31-Mar-2019 PHINDIRITBL  Number of health facilities operating on a daily basis (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 124.00 225.00 278.00 Date 03-Feb-2014 01-Feb-2015 01-Jul-2015 31-Mar-2019 Comments Source: Health facility baseline survey. As the number of facilities has increased to 278 due to the inclusion of Regions 4 and 5 in the AF, the end target is increased to 278. 9/2/2015 Page 5 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report CF-Health System Support Project (P119815) PHINDIRITBL  Number of health professionals available in health facilities on a monthly basis (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 124.00 258.00 500.00 Date 03-Feb-2014 01-Feb-2015 01-Jul-2015 01-Jul-2019 Comments Source: Health facility baseline report, May 2015. Added new sub-indicator: Percentage of health facilities in project areas with at least one qualified personnel PHINDIRITBL  Percentage of health facilities in project areas with at least one qualified personnel (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 36.00 -- 36.00 55.00 PHINDIRITBL  Number of children under age of five treated for Severe Acute Malnutrition (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 14077.00 12823.00 15411.00 16800.00 Date 30-Dec-2013 01-Feb-2015 01-Jul-2015 31-Mar-2019 Comments Source: Health facility montly HMIS reports, UN Agency quarterly reports, Ministry of Health quarterly summary report PHINDIRITBL  Number of health facilities submitting complete monthly HMIS reports (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 200.00 278.00 Date 01-Jul-2015 -- 01-Jul-2015 31-Mar-2019 Comments Source: Health facility baseline survey, May 2015. Target has been increased to 278 to include newly added regions 4 and 5. 9/2/2015 Page 6 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report CF-Health System Support Project (P119815) PHINDIRITBL  Number of health personnel trained in HMIS (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 460.00 Date 01-Jul-2015 -- 01-Jul-2015 31-Mar-2019 Comments Source: Health facility montly HMIS reports, UN Agency quarterly reports, Ministry of Health quarterly summary report Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P119815 IDA-51340 Effective USD 9.35 9.35 0.00 8.45 0.68 90% P119815 IDA-D0610 Effective USD 12.00 12.00 0.00 0.00 12.19 0% P119815 IDA-H7840 Effective USD 7.65 7.65 0.00 6.89 0.57 90% P119815 TF-13380 Effective USD 11.20 11.20 0.00 2.17 9.03 19% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P119815 IDA-51340 Effective 17-May-2012 31-Jul-2012 28-Oct-2012 31-Mar-2018 31-Mar-2018 P119815 IDA-D0610 Effective 22-May-2015 19-Jun-2015 11-Aug-2015 31-Mar-2019 31-Mar-2019 9/2/2015 Page 7 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report CF-Health System Support Project (P119815) P119815 IDA-H7840 Effective 17-May-2012 31-Jul-2012 28-Oct-2012 31-Mar-2018 31-Mar-2018 P119815 TF-13380 Effective 31-Jul-2012 31-Jul-2012 28-Oct-2012 31-Mar-2018 31-Mar-2018 Cumulative Disbursements Restructuring History Level 1 Approved on 02-Apr-2014 ,Level 2 Approved on 06-Aug-2015 Related Project(s) P153030-Health System Support Project Additional Financing 9/2/2015 Page 8 of 8 Public Disclosure Copy