Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) Nigeria States Health Investment Project (P120798) AFRICA | Nigeria | Health, Nutrition and Population Global Practice | IBRD/IDA | Specific Investment Loan | FY 2012 | Seq No: 7 | ARCHIVED on 28-May-2015 | ISR19048 | Implementing Agencies: Key Dates Key Project Dates Board Approval date:12-Apr-2012 Effectiveness Date:20-Aug-2013 Planned Mid Term Review Date:22-Feb-2016 Actual Mid-Term Review Date:-- Original Closing Date:30-Jun-2018 Revised Closing Date:30-Jun-2018 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 Project Objective? No Components Name Results Based Financing using (i) PBF for outputs at health facilities and LGA PHC Departments (ii) DLI at State and LGA levels (iii ) DFF at the health facility level to compare with PBF.:(Cost $122.20 M) Component 2: Technical Support that will support reforms; institutional strengthening; implementation of PBF and DLI at the state, L GA and facility levels; and monitoring and evaluation.:(Cost $34.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Satisfactory Overall Implementation Progress (IP)  Satisfactory  Satisfactory Overall Risk Rating  --  Moderate 5/28/2015 Public Disclosure Copy Page 1 of 10 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) Implementation Status and Key Decisions Pre-pilot and initial scale-up LGA (nine LGAs) continue to show improvements in coverage of the majority of essential services although challenges still persist in the areas of HIV testing and postnatal care. In the last year, immunization coverage in scale-up facilities has gone from 24% to 50% in Adamawa, 49% to 59% in Ondo and 41% to 46% in Nasarawa. Similarly, institutional deliveries have increased from 29% to 40% in Adamawa, 20% to 26% in Ondo and 27% to 46 in Nasarawa. Coverage of both standard antenatal visits and postnatal consultations are still below 30%. In scale-up facilities, similar improvements have been recorded over the last four quarters of implementation. Immunization coverage has increased from 1% to 20% in Adamawa, 74% to 77% in Ondo and 28% to 48% in Nasarawa while institutional deliveries increased from 0% to 8% in Adamawa, and 29% to 32% in Ondo and Nasarawa. Results from the remaining LGAs are currently being verified.. Quality of care in health centers in pre-pilot LGA has been sustained with quality score of improvements of 62% to 77% in Adamawa, 82% to 86% in Nasarawa and 77% to 80% in Ondo. In scale-up LGA, quality of care improved between the first and fourth quarters of 2014 with increases from 10% to 51%, 39% to 66% and 42% to 65% in Adamawa, Nasarawa and Ondo respectively. The performance of secondary level hospitals in all the 9 LGAS on quality of care has improved tremendously but in terms of quantity the progress has been mixed especially on indicators on maternal health. The RBF technical assistance agency is fully in place and has just completed a round of quality counter – verification, which are required prior to payments. Multiple capacity building efforts are continuing at different levels. The baseline household survey (part of the impact evaluation) has been completed, it shows both from the household survey and health facility survey that the pre-pilot facilities did very well on key indicators. The project is on track to achieve its development objectives. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  --  Moderate 5/28/2015 Public Disclosure Copy Page 2 of 10 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) Macroeconomic  --  --  Substantial Sector Strategies and Policies  --  --  Low Technical Design of Project or Program  --  --  Low Institutional Capacity for Implementation and Sustainability  --  --  Low Fiduciary  --  --  Moderate Environment and Social  --  --  Low Stakeholders  --  --  Low Other  --  --  -- Overall  --  --  Moderate Results Project Development Objective Indicators PHINDPDOTBL  Number of 12-23 month old children fully immunized (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 270644.00 -- 209067.00 378900.00 Date 31-Dec-2008 -- 31-Dec-2014 31-Jul-2018 PHINDPDOTBL  Proportion of 12-23 month old children fully immunized (Adamawa) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 22.10 22.10 22.10 49.00 PHINDPDOTBL  Proportion of 12-23 month old children fully immunized (Nasarawa) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 17.00 17.00 17.00 45.00 5/28/2015 Public Disclosure Copy Page 3 of 10 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) PHINDPDOTBL  Proportion of 12-23 month old children fully immunized (Ondo) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 27.80 27.80 27.80 53.00 PHINDPDOTBL  Number of children (12-23) months fully immunized (Nasarawa) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 86237.00 -- 41038.00 120731.00 Date 31-Dec-2010 -- 31-Dec-2014 31-Jul-2018 PHINDPDOTBL  Number of children (12-23 months) fully immunized (Ondo) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 106227.00 -- 105903.00 148717.00 Date 31-Dec-2010 -- 31-Dec-2014 31-Jul-2018 PHINDPDOTBL  Numberof children (12-23 months) fully immunized (Adamawa) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 78180.00 -- 62126.00 109452.00 Date 31-Dec-2010 -- 31-Dec-2014 31-Jul-2018 PHINDPDOTBL  Births (deliveries) attended by skilled health personnel (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 76960.00 -- 130771.00 88503.00 Date 31-Dec-2010 -- 31-Dec-2014 31-Jul-2018 5/28/2015 Public Disclosure Copy Page 4 of 10 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) PHINDPDOTBL  Proportion of births attended by skilled health personnel (Adamawa) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 40.70 40.70 40.70 25.00 PHINDPDOTBL  Proportion of births attended by skilled health personnel (Nasarawa) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 62.50 62.50 62.50 45.00 PHINDPDOTBL  Proportion of births attended by skilled health personnel (Ondo) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 74.60 74.60 74.60 60.00 PHINDPDOTBL  Number of births attended by skilled health personnel (Nasarawa) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 23193.00 -- 37972.00 26671.00 Date 31-Dec-2010 -- 31-Dec-2014 31-Jul-2018 5/28/2015 Public Disclosure Copy Page 5 of 10 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) PHINDPDOTBL  Number of births attended by skilled health personnel (Ondo) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 29247.00 -- 40509.00 33634.00 Date 31-Dec-2010 -- 31-Dec-2014 31-Jul-2018 PHINDPDOTBL  Number of births attended by skilled health personnel (Adamwa) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 24520.00 -- 52290.00 28198.00 Date 31-Dec-2010 -- 31-Dec-2014 31-Jul-2018 PHINDPDOTBL  Average Health Facility Quality of Care Score (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 69.90 41.66 61.00 Date -- 30-Jun-2014 31-Mar-2014 31-Jul-2018 Comments The baseline health facility survey shows that the average health facility quality of care study is 41.66% for all project facilities in the 52 LGAs in the three states.. The earlier figure of 69.9% was for health facilities in 3pre-pilot LGAs. PHINDPDOTBL  Number of outpatient visits by children under five (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 346990.00 -- 1190455.00 388598.00 Date 31-Dec-2010 -- 31-Dec-2014 31-Jul-2018 PHINDPDOTBL  Direct project beneficiaries (Number, Core) 5/28/2015 Baseline ActualCopy Public Disclosure (Previous) Actual (Current) Page 6 of 10 End Target Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) Value 0.00 -- 638648.00 3000000.00 Date -- -- 31-Dec-2014 31-Jul-2018 PHINDPDOTBL  Female beneficiaries (Percentage, Core Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 63.00 60.00 Overall Comments Global Environmental Objective Indicators Overall Comments Intermediate Results Indicators PHINDIRITBL  TB Case Detection Rate (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 30.50 -- -- 43.00 Date 31-Dec-2008 -- -- 31-Jul-2018 PHINDIRITBL  Proportion of on-duty technical staff present at health facility on the day of the survey. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 59.20 84.00 Date -- -- 31-Mar-2014 31-Jul-2018 Comments Data from baseline health facility survey 5/28/2015 Public Disclosure Copy Page 7 of 10 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) PHINDIRITBL  Proportion of primary health facilities having essential medicines and commodities in stock (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 18.30 35.00 Date -- -- 31-Mar-2014 31-Jul-2018 Comments Data from baseline health facility survey PHINDIRITBL  Number of LGA with ongoing PBF pilot (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 19.00 26.00 27.00 Date 31-Dec-2011 31-Oct-2014 30-Apr-2015 30-Jun-2015 PHINDIRITBL  Number of LGAs receiving grants linked to performance (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 19.00 26.00 30.00 Date 31-Aug-2013 31-Oct-2014 30-Apr-2015 31-Dec-2017 5/28/2015 Public Disclosure Copy Page 8 of 10 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) PHINDIRITBL  Number of states disclosing report cards detailing LGA level performance made available in public domain (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 3.00 3.00 Date -- -- 30-Mar-2015 30-Jun-2015 Overall Comments Data from DLI report for 2014 Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P120798 IDA-50940 Effective USD 150.00 150.00 0.00 50.95 88.84 34% P120798 TF-13432 Effective USD 20.00 20.00 0.00 6.80 13.20 34% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. 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 Cumulative Disbursements 5/28/2015 Public Disclosure Copy Page 9 of 10 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) Restructuring History There has been no restructuring to date. Related Project(s) P149936-Nigeria State Health Investment Project (NSHIP) Additional Financing 5/28/2015 Public Disclosure Copy Page 10 of 10