The World Bank Report No: ISR16653 Implementation Status & Results Nigeria Nigeria States Health Investment Project (P120798) Public Disclosure Copy Operation Name: Nigeria States Health Investment Project (P120798) Project Stage: Implementation Seq.No: 6 Status: ARCHIVED Archive Date: 18-Nov-2014 Country: Nigeria Approval FY: 2012 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 12-Apr-2012 Original Closing Date 30-Jun-2018 Planned Mid Term Review Date 22-Feb-2016 Last Archived ISR Date 25-May-2014 Effectiveness Date 20-Aug-2013 Revised Closing Date 30-Jun-2018 Actual Mid Term Review Date Project Development Objectives Nigeria States Health Investment Project (P120798) Project Development Objective (from Project Appraisal Document) To increase the delivery and use of high impact maternal and child health interventions and improve quality of care at selected health facilities in the participating states. Has the Project Development Objective been changed since Board Approval of the Program? Yes No Component(s) Component Name Component Cost Results Based Financing using (i) PBF for outputs at health facilities and LGA PHC Departments (ii) 122.20 DLI at State and LGA levels (iii ) DFF at the health facility level to compare with PBF. Component 2: Technical Support that will support reforms; institutional strengthening; implementation 34.00 of PBF and DLI at the state, L GA and facility levels; and monitoring and evaluation. Overall Ratings Public Disclosure Copy Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating High High Implementation Status Overview Results of the Performance Based Financing (PBF) pre-pilot in 3 Local Government Areas (LGAs): In the last two quarters, there has been overall increase in the coverage of essential services while the facilities still struggle with HIV, Malaria and post natal consultations. Specifically coverage for institutional delivery in health facilities went from 44% to 60% in Wamba (Nasarawa), 43% to 40% in Fufore (Adamawa) and from 30% to 45% in Ondo East (Ondo). Coverage for completely vaccinated child has gone from 38% to 50% in Fufore, remained between 48 and 47% in Wamba and from 64% to 82% in Ondo East. Postnatal consultation and uptake of modern family planning methods, though increased in all Page 1 of 6 The World Bank Report No: ISR16653 three states, remains low especially in Adamawa. In Fufore, post natal consultation is still almost zero. General Hospital performance has increased moderately. There is seeming decline in quality scores [Fufore to 63%, Wamba: 77% and Ondo East 69.9%] but this is , largely due to a readjustment of the quality checklists. Overall scaling-up is going smoothly and will be finalized by mid-December 2015: Nassarawa completed all trainings for PBF and DFF LGAs, whereas both Ondo and Adamawa Public Disclosure Copy States will complete all trainings by end 2015. Currently 19 LGAs are implementing Performance Based Financing (PBF) while 18 LGAs are implementing Decentralized Facility Financing (DFF) - 37 out of the 52 LGAs in the three states are already covered. It is significant to note that this scaling-up has been achieved through local capacity development. Results from Phase 1 scale-up facilities has started to show improvement particularly in their second quarter of implementation. Institutional deliveries increased from 5% to 19% in Mayo-Belwa (Adamawa), 26% to 37% in Karu (Nasarawa) and from 12% to 13% in Ile-Oluji/Okeigbo (Ondo). The coverage for completely vaccinated child went from 0% to 12% (Mayo-Belwa), 22% to 68% (Karu) and 55% to 62% - Ile-Oluji (end of Quarters 1 and 2, respectively) in the three states. At the moment, NPHCDA and the Bank are processing the disbursement linked indicators (DLI) for 2013 for the three (3) states. The RBF technical assistance agency completed its inception visit in October 2014. Multiple capacity building efforts are ongoing at different levels while the training of the PBF interns was completed in April/May and many of them have been absorbed into the State Primary Health care Development Agencies (SPHCDA) to work as coaches to the health facilities. The baseline household survey (part of the impact evaluation) has been completed and the report is being finalized.The project is on track to achieve its development objectives.. Locations Country First Administrative Division Location Planned Actual Nigeria Not Entered Ondo State Nigeria Not Entered Adamawa State Nigeria Not Entered Nasarawa State Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of 12-23 month old children fully Number Value 270644.00 378900.00 immunized Date 31-Dec-2008 31-Jul-2018 Comments This is the addition of the This will be compile in number of immunized children December 2014 for the period for the 3 states for 2008 of project implementation Public Disclosure Copy (Adamawa: 78,280; Nasarawa: 86,237; Ondo: 106,227) Proportion of 12-23 month old children fully Percentage Value 22.10 22.10 49.00 immunized (Adamawa) Sub Type Supplemental Page 2 of 6 The World Bank Report No: ISR16653 Proportion of 12-23 month old children fully Percentage Value 17.00 17.00 45.00 immunized (Nasarawa) Sub Type Supplemental Public Disclosure Copy Proportion of 12-23 month old children fully Percentage Value 27.80 27.80 53.00 immunized (Ondo) Sub Type Supplemental Births (deliveries) attended by skilled health Number Value 76960.00 88503.00 personnel (number) Date 31-Dec-2010 31-Dec-2017 Comments This is the addition of the This will be compile in number of births for the 3 December 2014 for the period states for 2010 (Adamawa: of project implementation 24,520; Nasarawa: 23,193; Ondo: 29,247). Proportion of births attended by skilled health Percentage Value 40.70 40.70 25.00 personnel (Adamawa) Sub Type Supplemental Proportion of births attended by skilled health Percentage Value 62.50 62.50 45.00 personnel (Nasarawa) Sub Type Supplemental Proportion of births attended by skilled health Percentage Value 74.60 74.60 60.00 personnel (Ondo) Sub Type Supplemental Average Health Facility Quality of Care Score Percentage Value 0.00 69.90 Date 30-Jun-2014 Comments The value will be obtained Data for pre pilot LGAs. Baseline plus 20 percentage from the baseline health Results of baseline health points facility survey facility survey will be ready by November 30 2014 and we Public Disclosure Copy will be able to get the baseline value for all facilities and base this indicator on value for all facilities. (not the pre-pilot facilities alone) Number of outpatient visits by children under Number Value 346990.00 388598.00 five Date 31-Dec-2010 31-Dec-2017 Comments This represents addition of This will be compile in This represents addition of values for two states - values for two states - Page 3 of 6 The World Bank Report No: ISR16653 Nasarawa (36,591) and Ondo December 2014 for the period Nasarawa (40,982) and Ondo (301,372). of project implementation (347,616) Direct project beneficiaries Number Value 0.00 Public Disclosure Copy Date 31-Dec-2017 Comments This will be compile in Female beneficiaries target: December 2014 for the period Baseline plus 10 percentage of project implementation points Female beneficiaries Percentage Value 0.00 Sub Type Supplemental Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target TB Case Detection Rate Percentage Value 30.50 43.00 Date 31-Dec-2008 31-Jul-2018 Comments National TB & Leprosy No new figure as project Control Program Annual scale-up has not fully Report commenced Proportion of on-duty technical staff present at Percentage Value 0.00 health facility on the day of the survey. Date 31-Jul-2018 Comments Baseline Values will be Results of baseline health Baseline plus 25 percentage available by August 2014 facility survey will be ready by points November 30 2014 Proportion of primary health facilities having Percentage Value 0.00 essential medicines and commodities in stock Date 31-Jul-2018 Comments Baseline Values will be Results of baseline health Baseline plus 15 percentage available by August 2014 facility survey will be ready by points November 30 2014 Number of LGA with ongoing PBF pilot Number Value 3.00 19.00 27.00 Public Disclosure Copy Date 31-Dec-2011 31-Oct-2014 30-Jun-2015 Comments PBF and DFF scale up is ongoing and the scale up has been completed in Nasarawa State. The other states might complete the scale upin December 2014 Number of LGAs receiving grants linked to Number Value 0.00 19.00 30.00 performance Date 31-Aug-2013 31-Oct-2014 31-Dec-2017 Page 4 of 6 The World Bank Report No: ISR16653 Comments Project implementation has not commenced Number of states disclosing report cards Number Value 0.00 3.00 Public Disclosure Copy detailing LGA level performance made Date 30-Jun-2015 available in public domain Comments Project implementation has No new figure as project not commenced scale-up has not fully commenced Data on Financial Performance (as of 31-Oct-2014) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P120798 IDA-50940 Effective 12-Apr-2012 16-Apr-2013 20-Aug-2013 30-Jun-2018 30-Jun-2018 P120798 TF-13432 Effective 16-Apr-2013 16-Apr-2013 20-Aug-2013 30-Jun-2018 30-Jun-2018 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P120798 IDA-50940 Effective USD 150.00 150.00 0.00 43.10 100.98 29.00 P120798 TF-13432 Effective USD 20.00 20.00 0.00 4.61 15.39 23.00 Disbursement Graph Public Disclosure Copy Page 5 of 6 The World Bank Report No: ISR16653 Key Decisions Regarding Implementation None Public Disclosure Copy Restructuring History There has been no restructuring to date. Related Projects P149936-Nigeria State Health Investment Project (NSHIP) Additional Financing Public Disclosure Copy Page 6 of 6