The World Bank Health Services Improvement Project (P145335) REPORT NO.: RES41092 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF HEALTH SERVICES IMPROVEMENT PROJECT APPROVED ON MARCH 21, 2014 TO REPUBLIC OF ZAMBIA HEALTH, NUTRITION AND POPULATION GLOBAL PRACTICE AFRICA REGION Regional Vice President: Hafez M. H. Ghanem Country Director: Mara K. Warwick Regional Director: Dena Ringold Practice Manager: Ernest E. Massiah Task Team Leaders: Musonda Rosemary Sunkutu, John Bosco Makumba The World Bank Health Services Improvement Project (P145335) ABBREVIATIONS AND ACRONYMS CPD Continuous Professional Development CERIP Contingent Emergency Response Implementation Plan CERC Contingent Emergency Response Component COVID-19 Coronavirus Disease DRC Democratic Republic of Congo DLI Disbursement-linked Indicator DLR Disbursement-linked Results EBS Event-based Surveillance e-IDSR Electronic Integrated Disease Surveillance and Response EVD Ebola Virus Disease FETP Field Epidemiology Training Program GBV Gender-based Violence GMP Growth Monitoring and Promotion HRITF Health Results Innovation Trust Fund IBS Indicator-based Surveillance IDA International Development Association MDTF Multi-Donor Trust Fund MOH Ministry of Health MSL Medical Stores Limited PDO Project Development Objective PHC Primary Health Care PHEIC Public Health Emergency of International Concern RBF Results-based Financing RMNCAH-N Reproductive, Maternal, Neonatal, Child and Adolescent Health and Nutrition RF Results Framework SDR Special Drawing Rights US$/USD United States Dollar WHO World Health Organization ZHSIP Zambia Health Services Improvement Project 1 The World Bank Health Services Improvement Project (P145335) BASIC DATA Product Information Project ID Financing Instrument P145335 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 21-Mar-2014 30-Jun-2020 Organizations Borrower Responsible Agency Ministry of Finance (Republic of Zambia) Ministry of Health Project Development Objective (PDO) Original PDO The project development objective is "to improve health delivery systems and utilization of maternal, newborn and child health andnutrition services in project areas." OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-53940 21-Mar-2014 11-Feb-2015 31-Mar-2015 30-Jun-2020 52.00 45.11 1.93 TF-16639 11-Feb-2015 11-Feb-2015 31-Mar-2015 30-Jun-2020 15.00 12.57 2.43 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No 2 The World Bank Health Services Improvement Project (P145335) 5 The World Bank Health Services Improvement Project (P145335) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Project Status 1. The Zambia Health Services Improvement Project (ZHSIP) was approved by the Board on March 21, 2014 and became effective on March 31,2015. By May 31, 2020, a total of US$57.7 million equivalent (IDA US$45.1 million equivalent; Health Results Innovation Trust Fund of US$12.6 million) has been disbursed out of a US$67 million equivalent envelope (IDA US$52 million equivalent; HRITF US$15 million), giving an overall disbursement ratio of 93% percent. With a proposed closing date of December 31, 2020, the project will be effective for a total duration of 6 years and 9 months. 2. Overall, progress has been made under the project. The project has made positive gains and has put in place strong platforms for health system reforms by introducing performance based financing through disbursement-linked indicators (DLIs) at the national level, as well as introducing results-based financing (RBF) at the district, health facility (hospital and health centers) and community levels. Moving forward, these platforms will support the Government of Zambia’s proposed move towards output-based financing and a focus on results. 3. The project has made good progress towards the achievement of the project development objective (PDO). Three out of the five PDO-level indicators have been achieved, with two of the indicators projected to surpass their end targets by June 30, 2020. Details of the PDOs that lagging are provided below: (i) Under-2-children receiving monthly growth monitoring and promotion (GMP) based on new standard guidelines1 in project areas: While the project has generated positive demand for GMP services through community outreach, as reflected by the increasing number of under-2 children being weighed2, the indicator falls short of providing comprehensive GMP based on the new standard guidelines. In addition, the partial achievement of the indicator on weight alone does not respond to the achievement of DLII#9 on the number of Outreach centers in targeted provinces conducting GMP monitoring following national standards and guidelines increases. Out of 1089 health facilities in the project sites, only 33 percent (363) of health facilities were providing GMP according to the new standard guidelines and only 37 percent of under-2-children were reached in 2019 with GMP according to new standard guidelines in the project areas, an increase from 13 percent reached in 2018 following the MTR recommendations to expand and strengthen the community service delivery platform to help address the substantial systemic supply-side and demand- side challenges in nutrition including the non-adherence new standard guidelines in provision of GMP at health facility and community levels . (ii) “Health facilities (health post, health centers and district hospitals) with all tracer drugs, vaccines and nutritional commodities in stock nationally”: This will not be achieved mainly due to the low levels of government spending in the health sector, consequently affecting the ability to procure essential drugs and supplies. The allocation of resources has shrunk even further recently given the country’s poor economic performance and the high public debt, which maybe further exacerbated by the Coronavirus disease (COVID-19) pandemic. 4. The project implementation progress is satisfactory. Under Component 1, the project has enhanced the capacities of nurses and midwives through specialized pre-service and in-service training and continuous professional development (CPD) in the following technical areas: management of Reproductive, Maternal, Neonatal, Child and Adolescent Health 1The GMP measurement based on new standard guideline involves taking anthropometry measurements of weight, length/ height, and middle upper arm circumference (MUAC) of children including counselling, health education and cooking demonstrations to increase awareness about the child's growth status. 2 The number of under-2 children weight increased from 61 percent in 2018 to 82.4 percent in 2019 in project areas. 6 The World Bank Health Services Improvement Project (P145335) and Nutrition (RMNCAH-N); health financing; and drugs and medical supply chain management. Specific achievements include: (i) Institutional strengthening of nine (9) training institutions (TI)3 in five target provinces to deliver an integrated and comprehensive pre-service education package on maternal, neonatal, and child health (MNCH) and nutrition, including content on gender-based violence (GBV) to nursing students; and (ii) Strengthening training capacity at seven general hospitals (level II), with a total of 14,346 nurses and midwives trained through pre-service, in-service and CPD. In addition, the project has improved supply chain systems by supporting the finalization and approval of the National Supply Chain Strategy, that led to the establishment of: (i) Seven regional hubs for the storage and distribution of drugs; (ii) Improved secondary distribution of drugs and commodities to health facilities; and (iii) Increased the capacity of the Central Warehouse at Medical Stores Limited (MSL) by improving information systems and connectivity between the Central Warehouse and regional Hubs. Lastly, the project has improved the referral system and linkages across different levels of healthcare by: (i) Facilitating the development of a comprehensive RMNCAH-N package for the primary health care (PHC) level, the National Community Health Strategy (NCHS) 2019-2021, and other health protocols and guidelines4; (ii) Procurement and distribution of ambulances, motorcycle ambulances, and bicycles; (iii) Refurbishment and renovation of select outreach centers; (iv) Engagement and orientation of community chiefs on RMNCAH-N issues, including early marriage, teenage pregnancies and GBV, under the theme “Chiefs Providing Leadership for Health and Wellness, Leaving No One Behind”; and (v) Strengthening community platforms for service delivery. 5. The first project restructuring, approved on August 7, 2019, added Sub-component 1.4 with corresponding indicators to Component 1 to support scaling up of select high impact interventions in MNCH and nutrition5 to accelerate reduction in maternal and neonatal morbidity and mortality. This addition was financed through transaction-based financing. 6. Under Component 2, the use of Results Based Financing has contributed to an upward trend in key RMNCAH-N indicators, facilitated fiscal decentralization through direct disbursement of funds from the central level to beneficiary health facilities, strengthened managerial autonomy at the PHC level, and helped reinforce referral linkages and improvements in the quality of care for MNCH services at health facilities. RBF is now being implemented in a total of 60 districts across the five target provinces, covering a total of 964 health facilities, and representing 94% of all the health posts/ health centers and 35% of all the district hospitals. In addition, about half of RBF-implementing facilities in each district have also been implementing RBF approaches at community level through the Neighborhood Health Committees (NHCs). The supply and demand side interventions that have been put in place have led to an increase in the utilization of health services, as demonstrated by an improved performance on all RBF-incentivized maternal, child health and nutrition indicators. 7. Under Component 3, the following areas were financed: (i) the development, roll out and integration of the community health management information systems (CHMIS) into the district health information systems (DHIS-2); (ii) development of an integrated human resource information system (iHMIS); (iii) evidence-based analytical studies6 ; and 3 Mansa School of Registered Nursing and St Pauls Enrolled Nursing Training School in Luapula province; Chilonga, Our Lady Enrolled Midwifery and Nursing School in Muchinga province; Kalene School of Nursing, Mukinge School of Nursing and Midwifery, Solwezi School of Nursing in North-Western province; Kasama School of Registered Nursing in Northern province and Lewanika Enrolled Nursing/ Midwifery School and Kaoma School of Nursing in Western province. 4 These include: (i) New standard guidelines on Growth Monitoring and Promotion (GMP) and protocols; (ii) Pregnancy, Child Health, Postpartum and Newborn Care: Agenda for Essential Practices in Zambia 2016; (iii) Neighborhood Health Committee Guidelines 2018; (iv) Currently revising the Antenatal Care (ANC) Guidelines for a positive pregnancy experience for pregnant women and adolescents - currently in draft; and (iv) Zambia National Maternal and Neonatal Referral Guidelines. 5 These high impact interventions include: (i) Malaria Elimination Program through targeted indoors residual spraying (IRS), done in partnership with the Global Fund (GF) who will procure all insecticides, and the project will support operational costs; (ii) Scaling up neonatal care and cervical cancer screening at PHC level in select health facilities in the targeted provinces. 6 These include: (i) The National Rational Drug Use study to inform policy on prescription behavior and appropriate use of drugs. The recommendations of the report will be used to revise policy documents and guidelines of medicine use; (ii) National Health Accounts (NHA) 2013-2016 survey; (iii) Support to Zambia Public Health Expenditure Review (PER); (iv) Assessment of utilization of ANC services in five provinces of Zambia; and (v) Factors affecting attendance for postnatal services in the project areas. 7 The World Bank Health Services Improvement Project (P145335) (iv) training for mid-level Managers in the Ministry of Health (MOH) to enhance their analytical and operational knowledge in health financing, planning and budgeting, and HR management and development. 8. Contingent Emergency Response Component (CERC) was activated on March 31, 2020 and this restructuring is a follow up to the activation of the CERC. 9. Procurement and the limited fiscal space to finance DLIs at the MOH remains a challenge, negatively affecting implementation progress. The overall implementation progress was rated moderately unsatisfactory, lowered by an unsatisfactory procurement rating due to project-related procurement challenges. For procurement, the last Implementation Status Result Report (ISR) details the inadequacies of the procurement management arrangements and the high-risk rating of the project, which is a result of: the absence of a MOH procurement specialist conversant with World Bank regulations; the lack of adherence to the procurement plan, and lack of communication with the World Bank in case of changes when implementing some procurement assignments; and the lack of an effective contract management system within the ministry. The MOH recently seconded a Procurement Specialist to the project and is closely monitoring the implementation of the overall ZHSIP procurement plan, including the procurement plan for the Contingent Emergency Response Component (CERC). For limitations on fiscal space, the use of DLIs requires the Government of Zambia to frontload DLI disbursements in a timely manner in advance. This has become increasingly difficult for the MOH to achieve DLI to facilitate the disbursement of additional funds, due to Government’s limited fiscal space to frontload disbursements of agreed activities. The delays in achieving DLIs also negatively affects the implementation of the procurement plan. From the fiduciary, there are no overdue IFR under the IDA and Trust fund. B. Rationale for Restructuring 10. The last amendment to the Financing Agreement resulted in the addition of the CERC as Component 4 to provide immediate financing for the Ebola Virus Disease (EVD) preparedness and response. On July 17, 2019, the World Health Organization (WHO) declared the EVD outbreak in the Democratic Republic of Congo (DRC) a Public Health Emergency of International Concern (PHEIC). Although major strides have been made to contain the EVD outbreak in DRC, the risk of transmission of the EVD is still a concern and the WHO has not yet lifted the PHEIC warning for EVD. 11. The first project restructuring was approved on August 7, 2019. This is the second project restructuring and is based on the Government’s letter of request, received on March 16, 2020, for project restructuring and the activation of the CERC to: (i) Prepare for and provide an immediate and effective response to the EVD emergency; (ii) Extend the closing date for six (6) months (from June 30, 2020 to December 31, 2020); (iii) Convert three DLIs to input financing; (iv) Reallocate funds among components and categories; (v) Amend the PDO to add the CERC outcome; (vi) Revise the Results Framework (RF) to: a. add one CERC PDO indicator; b. add three CERC intermediate indicators; c. drop the indicator on “health facilities with all tracer drugs, vaccines, and nutritional commodities in stock nationally,” as this indicator may not be achieved due to Government inability to finance procurement of essential commodities; and d. change the end-line targets of all the indicators, as the current targets are too high for the resources available to achieve them. 8 The World Bank Health Services Improvement Project (P145335) II. DESCRIPTION OF PROPOSED CHANGES A. Detailed Proposed Changes 12. Change in Project Closing Date: The project closing date will be extended by six months from June 30, 2020 to December 31, 2020 to allow the Government to complete project activities, including implementation of the Contingent Emergency Response Implementation Plan (CERIP). This is the second no cost extension of the closing date from June 30, 2020 to December 31, 2020 making it six years and nine months since project approval on March 21, 2014. The project extension will only be for the IDA Credit 53940, while the MDTF HRITF (TF016639) will close as scheduled on June 30, 2020. Most of the resources under the grant have been disbursed, except for US$1,203,878.76 that will be used for direct payments for procurement of ultra-sound machines and under-five cards. All funds under the grant are expected to be fully disbursed by the original planned closing date of June 30, 2020. 13. Changes to the PDO. The proposal is to change the PDO from “to improve health delivery systems and utilization of maternal, newborn and child health, and nutrition services in project areas” to the following by adding a CERC outcome: “to improve health delivery systems and utilization of maternal, newborn and child health, and nutrition services in project areas and to prepare for and provide an immediate and effective response to the EVD emergency.” 14. Changes in the RF. The proposed revisions to the project’s RF are as follows: a. Revise the end-line targets for all indicators in the RF and to match with the new closing date, as the current targets are too high compared to the currently available resources following reallocation to the CERC. Additionally, the low levels of government spending to the health sector make it difficult to frontload the financing of activities to achieve the DLIs (see detailed changes in the RF). b. Add one CERC PDO indicator – “High-risk districts with strengthened surveillance for rapid detection and isolation of EVD cases (percentage).” c. Drop the indicator on “health facilities (health post, health centers and district hospitals) with all tracer drugs, vaccines, and nutritional commodities in stock in project areas (percentage),” as this indicator may not be achieved moving forward due to low levels of government spending to the health sector as stated above. d. Add three CERC intermediate indicators. See Table 1 below. Table 1. CERC Intermediate Indicators to be added to the RF New Intermediate Result Indicators Data Source 1. High-risk districts with fully functional event-based Electronic Integrated Disease Surveillance surveillance systems in place (number). and Response (e-IDSR) - Indicator-based surveillance (IBS) and event-based surveillance (EBS) 2. Staff trained in Field Epidemiology Training EBS System Program (FETP), surveillance and response (number). 3. Personnel (including community volunteers) Training Database and Reports. trained in risk communication (number). 15. Changes in Disbursement Categories and Reallocations Among Disbursement Categories. 9 The World Bank Health Services Improvement Project (P145335) (a) Drop three disbursement-linked results (DLRs) and convert to input-based financing disbursed on actuals: (i) DLR#4.7 - Percentage point increase from the baseline in the number of Primary health care (PHC) facilities in targeted provinces stocked with all tracer drugs by June 30, 2020 (SDR 1,250,000); (ii) DLR#7.7 - Percentage point increase from the baseline in the number of women registered during the first trimester of their pregnancy in targeted provinces by June 30, 2020 (SDR 385,000) and (iii) DLR#8.7 - Percentage point increase from the baseline in number of mothers who received post-natal care within 6 days of delivery in targeted provinces by June 30, 2020 (SDR 620,000). (b) Reallocate funds among disbursement categories. A total of SDR 2,255,000 converted to input financing (from DLR#4.7- SDR 1,250,000; DLR#7.7- SDR 385,000; and DLR#8.7- SDR 620,000) will be reallocated from category 1 under part A of the project to category 5 under part D of the project, and SDR 0.146 million will be moved from category 4 under part C7 of the project to category 3 under part C of the project. See Table 2 below. Table 2: Change in Expenditure Category under IDA Credit 53940 Project Category Original Project Project Category Cost Proposed Project Category Cost August 7, 2019 Project Category Cost (SDR (SDR million) Restructuring (SDR million) million) (1) DLI Based Financing under Part A of the Project 17.9 15.0 12.745 (2) Goods, services, Training and Operating Costs 7.9 7.9 7.9 required for Sub-Projects and to be financed out of Sub-project Grants under Part B of the Project (3) Goods, non- consulting services, consultant 6.8 6.8 6.946 services, Training and Operating Costs Under Part C of the Project (except under Part C.7 of the Project) (4) Consultants services under Part C.7 of the 1.3 0.3 0.154 Projects (5) Emergency Expenditures under Part D of the 0 0 2.255 Project (6) Goods, non-consulting services, consultant 0 3.9 3.9 services, Training and Operating Costs under Part A of the Project TOTAL AMOUNT 33.9 33.9 33.9 (c) Change in component costs and reallocation of funds: The proposal is to reallocate a total of US$3.1 million (SDR 2,255,000) from three DLRs proposed to be dropped above, to the CERC Component 4 to support EVD preparedness and response. Due to this reallocation, the first restructuring’s reallocation to Sub-component 1.4 to support high impact RMNCAH-N interventions, and in the light of the exchange rate losses that have been experienced under the project, there are inadequate financial resources to provide the required 50% allocation from IDA to match interventions under Component 2. The proposal is finance 100 percent of activities under Component 2 from HRITF resources. 10 The World Bank Health Services Improvement Project (P145335) Table 3: Project Costs and Financing by Component Original Allocation (US$ million) August 2019 Allocation (US$ Proposed Allocation (US$ million) million) Project Component Original IDA HRITF Component IDA HRITF Compon IDA HRITF Component Funding Funding Cost Funding Funding ent Cost Funding Funding Cost Component 1: Strengthen capacity for primary and 27.5 27.5 0 28.9 28.9 0 27.957 23.20 0 community level MNCH and nutrition services Component 2: Strengthen utilization of primary and community level MNCH 24 12 12 26.5 12 14.5 25.54 11.04 14.5 and nutrition services with results- based financing approaches Component 3: Strengthen project management and 15.5 12.5 3 11.6 11.1 0.5 10.408 9.72 0.5 policy analysis Component 4: Contingent Emergency Response NA NA NA 0 0 0 3.11 3.11 0 Component (CERC) Total Financing 67 52 15 67 52 15 67 47.07 15 The Proposed total Financing from IDA is US$62.07due to exchange losses of US$4.93m as at June 9, 2020 (Exchange rate SDR1 = US$1.381130). III. SUMMARY OF CHANGES Changed Not Changed Project's Development Objectives ✔ Results Framework ✔ PBCs ✔ Components and Cost ✔ Loan Closing Date(s) ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Disbursement Estimates ✔ Safeguard Policies Triggered ✔ 7 Incudes US$4,75m exchange losses. 8 Includes US$0.18m exchange losses. 11 The World Bank Health Services Improvement Project (P145335) Implementation Schedule ✔ Environmental Analysis ✔ Implementing Agency ✔ DDO Status ✔ Cancellations Proposed ✔ Overall Risk Rating ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_PDO_TABLE PROJECT DEVELOPMENT OBJECTIVE Current PDO The project development objective is "to improve health delivery systems and utilization of maternal, newborn and child health andnutrition services in project areas." Proposed New PDO The project development objective is "to improve health delivery systems and utilization of maternal, newborn and child health and nutrition services in project areas, and to prepare for and provide an immediate and effective response to the EVD emergency. OPS_DETAILEDCHANGES_COMPONENTS_TABLE COMPONENTS Current Current Proposed Proposed Cost Action Component Name Component Name Cost (US$M) (US$M) Component 1: Strengthening Component 1: Strengthening capacity for primary and capacity for primary and 27.50 Revised 27.95 community level MNCH and community level MNCH and nutrition services nutrition services 12 The World Bank Health Services Improvement Project (P145335) Component 2: Strengthening Component 2: Strengthening utilization of primary and utilization of primary and community level MNCH and community level MNCH and 24.00 Revised 25.54 nutrition services through nutrition services through results results based financing ap based financing ap proaches proaches Component 3: Strengthening Component 3: Strengthening project management and policy 15.50 Revised project management and 10.40 analysis policy analysis Component 4: Contingent Component 4: Contingent Emergency Response Component 0.00 Revised Emergency Response 3.11 (CERC) Component (CERC) TOTAL 67.00 67.00 OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-53940 Effective 30-Jun-2019 30-Jun-2020 31-Dec-2020 30-Apr-2021 TF-16639 Effective 30-Jun-2019 30-Jun-2020 30-Jun-2020 30-Oct-2020 OPS_DETAILEDCHANGES_REALLOCATION _TABLE REALLOCATION BETWEEN DISBURSEMENT CATEGORIES Financing % Current Allocation Actuals + Committed Proposed Allocation (Type Total) Current Proposed IDA-53940-001 | Currency: XDR iLap Category Sequence No: 1 Current Expenditure Category: DLI BASED FINANCING Part A 15,000,000.00 11,740,262.97 12,745,000.00 100.00 100.00 iLap Category Sequence No: 2 Current Expenditure Category: GD WK CON NON-C TRN OP sb prj PrB 7,900,000.00 7,899,915.58 7,900,000.00 50.00 0 iLap Category Sequence No: 3 Current Expenditure Category: GD CON N-CON TRN OP Prt C excptC7 13 The World Bank Health Services Improvement Project (P145335) 6,800,000.00 6,627,762.16 6,946,000.00 100.00 100.00 iLap Category Sequence No: 4 Current Expenditure Category: CONSULTANTS SERVICES Part C.7 300,000.00 126,873.91 154,000.00 40.00 40 iLap Category Sequence No: 5 Current Expenditure Category: EMERGENCY EXP PRT D 0.00 0.00 2,255,000.00 100.00 100.00 iLap Category Sequence No: 6 Current Expenditure Category: GDS,NCS,CS,TR,OC Prt A 3,900,000.00 461,993.76 3,900,000.00 100.00 100.00 Total 33,900,000.00 26,856,808.38 33,900,000.00 TF-16639-001 | Currency: USD iLap Category Sequence No: 1 Current Expenditure Category: GD WK CON NON-C TRN OP sb prj PrB 14,500,000.00 11,266,602.69 14,500,000.00 50.00 100 iLap Category Sequence No: 2 Current Expenditure Category: CONSULTANTS SERVICES Part C.7 500,000.00 263,048.44 500,000.00 60.00 60.00 Total 15,000,000.00 11,529,651.13 15,000,000.00 OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Change in Disbursement Estimates Yes Year Current Proposed 2014 0.00 0.00 2015 2,000,000.00 2,000,000.00 2016 4,589,013.14 4,589,013.14 14 The World Bank Health Services Improvement Project (P145335) 2017 9,889,160.87 9,889,160.87 2018 14,267,659.16 14,267,659.16 2019 13,169,069.71 5,711,739.66 2020 2,905,405.12 10,607,096.68 OPS_DETAILEDCHANGES_COMPLIANCE_TABLE COMPLIANCE Safeguard Policies Safeguard Policies Triggered Current Proposed Environmental Assessment (OP) (BP 4.01) No Yes Performance Standards for Private Sector No No Activities OP/BP 4.03 Natural Habitats (OP) (BP 4.04) No No Forests (OP) (BP 4.36) No No Pest Management (OP 4.09) No No Physical Cultural Resources (OP) (BP 4.11) No No Indigenous Peoples (OP) (BP 4.10) No No Involuntary Resettlement (OP) (BP 4.12) No No Safety of Dams (OP) (BP 4.37) No No Projects on International Waterways (OP) (BP No No 7.50) Projects in Disputed Areas (OP) (BP 7.60) No No . 15 The World Bank Health Services Improvement Project (P145335) . Results framework COUNTRY: Zambia Health Services Improvement Project Project Development Objectives(s) The project development objective is "to improve health delivery systems and utilization of maternal, newborn and child health andnutrition services in project areas." Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 5 Improve health delivery systems for MNCH and nutrition services Deliveries by skilled health providers in the project 27.00 48.00 52.00 54.00 57.00 75.00 80.00 areas (Custom) (Percentage) Action: This indicator has been Revised Health facilities (health post, health centres and district hospitals) with all PBC 4, tracer drugs, vaccines, and 33.30 38.30 51.00 52.50 53.00 53.00 4, 6, 6 nutritional commodities in stock in project areas (Custom,DLI) (Percentage) Action: This indicator has been Marked for Deletion 16 The World Bank Health Services Improvement Project (P145335) RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 5 Health centres (health post, health centres and district hospitals) offering integrated management of childhood Illnesses (IMCI) 0.00 13.00 51.00 60.00 64.00 65.00 based on new standard guidelines in the project areas (Custom) (Percentage) Action: This indicator has been Revised Improve utilization of MNCH and nutrition services Under-2 children received monthly growth monitoring and promotion (GMP) based on new standard 0.00 0.00 10.00 20.00 30.00 45.00 guidelines in the project areas (Custom). (Percentage) Action: This indicator has been Revised Fully immunized children at 12 months of age in the 80.00 82.00 86.00 88.00 90.00 95.00 project areas (Custom). (Percentage) Action: This indicator has been Revised 17 The World Bank Health Services Improvement Project (P145335) RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 5 Provide an immediate and effective response to the Ebola Virus disease (EVD) emergency (Action: This Objective is New) High risk districts with strengthened surveillance for rapid detection and 0.00 20.00 35.00 50.00 isolation of EVD cases. (Percentage) Action: This indicator is New PDO Table SPACE Intermediate Results Indicators by Components RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 Component 1: Strengthening capacity for primary and community level MNCH and nutrition services Health workers trained in MNCH and nutrition PBC 2, competencies in the targeted 0.00 50.00 150.00 200.00 300.00 400.00 2 provinces (Cumulative, Custom, DLI) (Number) Action: This indicator has been Revised Regional hubs and staging posts equipped countrywide PBC 5, 0.00 0.00 4.00 5.00 6.00 7.00 (Cumulative, Custom, DLI) 5 (Number) 18 The World Bank Health Services Improvement Project (P145335) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 Action: This indicator has been Revised Nurses and midwives trained in MNCH and nutrition competencies based on PBC 1, enhanced pre-service & in- 0.00 2,000.00 8,500.00 10,000.00 12,000.00 15,000.00 3, 3 service training and CPD in project areas (Cumulative, Custom, DLI) (Number) Action: This indicator has been Revised Rural health facilities (health post, health centers and district hospitals) with at least 19.00 40.00 55.00 65.00 75.00 95.00 one qualified health worker in the project areas (Custom) (Percentage) Action: This indicator has been Revised Health facilities (health post, health centers and district hospitals) conducting GMP 0.00 5.00 15.00 20.00 25.00 30.00 based on new standard guidelines in the project areas (Custom) (Percentage) Action: This indicator has been Revised 19 The World Bank Health Services Improvement Project (P145335) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 Outreach sites in targeted provinces conducting GMP based on new standard PBC 9, 0.00 100.00 300.00 500.00 800.00 1,000.00 guidelines in the project areas 9 (Cumulative, Custom, DLI) (Number) Action: This indicator has been Revised Health facilities (health centers and hospitals) conducting cervical cancer screening in 0.00 0.00 2.00 3.00 6.00 8.00 project areas (Custom) (Percentage) Action: This indicator has been Revised Structures protected by indoor residual spraying in project 1,052,313.00 1,100,000.00 1,100,000.00 areas (Custom) (Number) Action: This indicator has been Revised Health care providers and tutors Trained in essential newborn care (ENC) 0.00 130.00 200.00 competency-based training (Cumulative, Custom) (Number) 20 The World Bank Health Services Improvement Project (P145335) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 Action: This indicator has been Revised Component 2: Strengthening utilization of primary and community level MNCH and nutrition services Health facilities (health centers and district hospitals) implementing the RBF 70.00 100.00 275.00 365.00 545.00 900.00 approach in Project areas (Cumulative, Custom) (Number) Action: This indicator has been Revised Protocols and guidelines at community and primary care levels updated and 0.00 1.00 3.00 4.00 5.00 6.00 disseminated (Cumulative, Custom) (Number) Action: This indicator has been Revised People who have received essential health, nutrition, and 1,104,718.00 1,400,000.00 1,600,000.00 2,050,000.00 2,200,000.00 3,000,000.00 population (HNP) services (CRI, Number) Action: This indicator has been Revised People who have received essential health, nutrition, 883,798.00 1,120,000.00 1,280,000.00 1,640,000.00 1,760,000.00 2,400,000.00 and population (HNP) 21 The World Bank Health Services Improvement Project (P145335) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 services - Female (RMS requirement) (CRI, Number) Number of children 200,341.00 210,000.00 220,000.00 230,000.00 240,000.00 250,000.00 immunized (CRI, Number) Action: This indicator has been Revised Number of women and children who have received 683,030.00 1,270,000.00 1,550,000.00 1,700,000.00 2,100,000.00 2,450,000.00 basic nutrition services (CRI, Number) Action: This indicator has been Revised Number of deliveries attended by skilled health 221,377.00 230,000.00 250,000.00 260,000.00 270,000.00 300,000.00 personnel (CRI, Number) Action: This indicator has been Revised Women attending ANC within the first three months of PBC 7, 9.00 15.00 25.00 35.00 50.00 50.00 Pregnancy in the project areas 7 (Custom, DLI) (Percentage) Action: This indicator has been Revised Lactating women accessing PBC 8, 37.00 45.00 55.00 65.00 80.00 85.00 post-natal care within six days 8 22 The World Bank Health Services Improvement Project (P145335) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 in the project areas (Custom, DLI) (Percentage) Action: This indicator has been Revised Neighborhood health committees (NHCs) implementing the RBF 0.00 400.00 900.00 1,500.00 2,500.00 3,000.00 approach in the project areas (Cumulative, Custom) (Number) Action: This indicator has been Revised Component 3: Strengthening project management and policy analysis Health policy analysis conducted and results disseminated nationally 0.00 0.00 1.00 2.00 3.00 3.00 (Cumulative, Custom) (Number) Action: This indicator has been Revised Districts with community information system integrated DHIS-2 in project areas 0.00 10.00 25.00 35.00 39.00 45.00 (Cumulative, Custom) (Number) Action: This indicator has been Revised 23 The World Bank Health Services Improvement Project (P145335) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 NHCs implementing community health management information 0.00 300.00 1,000.00 1,500.00 1,800.00 2,200.00 system (CHMIS) in targeted in the project areas (Cumulative, Custom) (Number) Action: This indicator has been Revised Component 4: Contingent Emergency Response Component (CERC) (Action: This Component is New) High-risk districts with fully functional event-based 10.00 15.00 20.00 40.00 surveillance systems in place (Number) Action: This indicator is New Staff trained in field epidemiology training program 10.00 15.00 20.00 30.00 (FETP), surveillance and response (Number) Action: This indicator is New Personnel (including community volunteers) trained 40.00 70.00 100.00 150.00 in risk communication (Number) Action: This indicator is New IO Table SPACE 24 The World Bank Health Services Improvement Project (P145335) Performance-Based Conditions Matrix DLI IN00822782 ACTION PBC 1 Capacity to implement comprehensive pre-service training program on MNCH-N for nurses and midwives strengthened. Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Number 2,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 March 31, 2016 to October 8,500.00 0.00 31, 2018 March 31, 2015 to December 10,000.00 2,000,000.00 300000; 900000; 800000 31, 2020 DLI IN00822783 ACTION PBC 2 Health workers trained in MNCH and nutrition competencies in the targeted provinces (Cumulative, Custom, DLI) Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Number 2,600,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 March 31, 2016 to October 150.00 0.00 31, 2018 March 31, 2015 to December 400000; 500000; 500000; 500000; 200.00 2,600,000.00 31, 2020 700000 Action: This PBC has been Revised. See below. 25 The World Bank Health Services Improvement Project (P145335) DLI IN00859497 ACTION Number of vacancies for nurses and midwifes in primary health facilities filled by newly recruited nurses and midwifes who PBC 2 completed the 3-month induction in-service training on MNCH and nutrition Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Number 2,600,000.00 57.69 Period Value Allocated Amount (USD) Formula Baseline 0.00 March 31, 2016 to October 150.00 0.00 31, 2018 March 31, 2015 to December 200.00 2,600,000.00 400000; 500000; 500000; 100000; 0 31, 2020 DLI IN00822784 ACTION Nurses and Midwives in primary health facilities in Targeted Provinces who have completed the continuing professional PBC 3 development (CPD) training in MNCH-N increases. Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Number 2,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 March 31, 2016 to October 4,500.00 0.00 31, 2018 March 31, 2015 to December 250000;550000;400000; 6,000.00 2,000,000.00 31, 2020 400000;400000. Action: This PBC has been Revised. See below. 26 The World Bank Health Services Improvement Project (P145335) DLI IN00862737 ACTION Number of nurses and midwives in primary health facilities in targeted provinces who have completed the continuing PBC 3 professional development training in MNCH and nutrition. Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Number 2,000,000.00 100.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 March 31, 2016 to October 4,500.00 0.00 31, 2018 March 31, 2015 to December 250000;550000;400000; 6,000.00 2,000,000.00 31, 2020 400000;400000. DLI IN00822785 ACTION PBC 4 Primary health facilities in Targeted Provinces stocked with all tracer drugs increases Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome Yes Percentage 2,300,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 33.30 March 31, 2016 to October 51.00 0.00 31, 2018 March 31, 2015 to December 300000;400000;400000;500000;500 53.00 2,300,000.00 31, 2020 000;500000;48000 Action: This PBC has been Revised. See below. 27 The World Bank Health Services Improvement Project (P145335) DLI IN00830342 ACTION PBC 4 Number of primary health facilities in targeted provinces stocked with all tracer drugs Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome Yes Percentage 2,300,000.00 45.65 Period Value Allocated Amount (USD) Formula Baseline 33.30 March 31, 2016 to October 51.00 0.00 31, 2018 March 31, 2015 to December 300000;400000;400000;500000;500 53.00 2,300,000.00 31, 2020 000;500000;48000 Rationale: DLR4.7: 1,250,000 to be reallocated to the CERC DLI IN00822786 ACTION PBC 5 Regional hubs and staging posts equipped countrywide (Cumulative, Custom, DLI) Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Number 2,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 March 31, 2016 to October 4.00 0.00 31, 2018 March 31, 2015 to December 5.00 2,000,000.00 200000; 900000;900000 31, 2020 28 The World Bank Health Services Improvement Project (P145335) Action: This PBC has been Revised. See below. DLI IN00859506 ACTION PBC 5 Number of Regional essential commodities storage and distribution hubs established Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Number 2,000,000.00 100.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 March 31, 2016 to October 4.00 0.00 31, 2018 March 31, 2015 to December 5.00 2,000,000.00 200000; 900000;900000 31, 2020 DLI IN00822787 ACTION PBC 6 The electronic Zambia Inventory Control System (eZICS) is piloted and implemented in Targeted Provinces Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome Yes Percentage 2,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 March 31, 2016 to October 60.00 0.00 31, 2018 March 31, 2015 to December 200000;300000;600000;600000;300 60.00 2,000,000.00 31, 2020 000 Action: This PBC has been Revised. See below. 29 The World Bank Health Services Improvement Project (P145335) DLI IN00859498 ACTION PBC 6 The electronic Zambia Inventory Control System (eZICS) is piloted and implemented in targeted provinces Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome Yes Percentage 2,000,000.00 10.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 March 31, 2016 to October 60.00 0.00 31, 2018 March 31, 2015 to December 60.00 2,000,000.00 200000;0;0;0;0 31, 2020 DLI IN00822788 ACTION PBC 7 Women attending ANC within the first three months of Pregnancy in the project areas (Custom, DLI) Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 1,300,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 9.00 March 31, 2016 to October 25.00 0.00 31, 2018 March 31, 2015 to December 130000;200000;350000;350000;200 35.00 1,300,000.00 31, 2020 000;70000;18900 Action: This PBC has been Revised. See below. 30 The World Bank Health Services Improvement Project (P145335) DLI IN00830343 ACTION PBC 7 Number of women registered during the first trimester of their pregnancy in targeted provinces Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 1,300,000.00 70.38 Period Value Allocated Amount (USD) Formula Baseline 9.00 March 31, 2016 to October 25.00 0.00 31, 2018 March 31, 2015 to December 130000;200000;227500;87500;2000 35.00 1,300,000.00 31, 2020 00;70000 Rationale: DLR 7.7: 385,000 to be reallocated to the CERC DLI IN00822789 ACTION PBC 8 Lactating women accessing post-natal care within six days in the project areas (Custom, DLI) Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 2,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 37.00 March 31, 2016 to October 55.00 0.00 31, 2018 31 The World Bank Health Services Improvement Project (P145335) 200000; March 31, 2015 to December 65.00 2,000,000.00 400000;500000;500000;300000;100 31, 2020 000;32000 Action: This PBC has been Revised. See below. DLI IN00830364 ACTION PBC 8 Number of mothers who delivered at health facilities in targeted provinces and who received post-natal care Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 2,000,000.00 69.00 Period Value Allocated Amount (USD) Formula Baseline 37.00 March 31, 2016 to October 55.00 0.00 31, 2018 March 31, 2015 to December 200000;400000; 65.00 2,000,000.00 31, 2020 500000;125000;75000;80000 Rationale: DLR 8.7: 620,000 to be reallocated to the CERC DLI IN00822790 ACTION Outreach sites in targeted provinces conducting GMP based on new standard guidelines in the project areas (Cumulative, PBC 9 Custom, DLI) Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Number 1,700,000.00 0.00 Period Value Allocated Amount (USD) Formula 32 The World Bank Health Services Improvement Project (P145335) Baseline 0.00 March 31, 2016 to October 300.00 0.00 31, 2018 March 31, 2015 to December 200000;350000;400000;400000;250 500.00 1,700,000.00 31, 2020 000;100000;48000 Action: This PBC has been Revised. See below. DLI IN00859490 ACTION PBC 9 Number of Outreach Sites in targeted provinces conducting GMP based on new standard guidelines in the project areas Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Number 1,700,000.00 47.79 Period Value Allocated Amount (USD) Formula Baseline 0.00 March 31, 2016 to October 300.00 0.00 31, 2018 March 31, 2015 to December 200000;350000;100000;100000;625 500.00 1,700,000.00 31, 2020 00;0;48000 Verification Protocol Table: Performance-Based Conditions DLI_TBL_VERIFICATION PBC 1 Capacity to implement comprehensive pre-service training program on MNCH-N for nurses and midwives strengthened. DLI #1: Capacity to implement comprehensive pre-service training program on MNCH and nutrition for nurses and midwives strengthened Description DLR#1.1: An updated pre-service training curriculum on MNCH and nutrition for the training of nurses and midwives has been adopted in FY 2014 and all Targeted Training Institutions have prepared their capacity building plans- Protocol: (a) 33 The World Bank Health Services Improvement Project (P145335) Evidence of adoption of the updated pre-service training curriculum means that it will be approved officially by the GNC Board. The approved curriculum will be made available to the Bank for vetting by the MoH with official minutes of the meeting of the GNC Board at which it was approved. (b) The Targeted Training Institutions will have presented to the MoH, their capacity building plans and the plans have been approved by the Permanent Secretary, MoH. The plans must identify “capacity gaps” that are to be addressed in order for the institutions to deliver the new curriculum particularly in MNCH and nutrition, with an indication of how these gaps will be addressed. The plans will be made available to the Bank for vetting by the MoH. Each of the 2 components comprise 50% of the value of the DLI. DLR#1.2: At least four (4) of the Targeted Training Institutions have addressed the capacity gaps identified in their respective Capacity Building Plans in FY 2015- Protocol: At least 4 of the Targeted Training Institutions have taken concrete actions to address the gaps identified in their capacity building plans. These actions include: (i) Funds for the 4 training institutions have been disbursed and at least 50 percent of the funds have been spent on identified areas in the capacity building plans, (ii) 4 training institution have been oriented on the new curriculum by GNC, (iii) The new curriculum is being delivered by four training institutions. The external verification firm will be responsible for gathering evidence while the MoH will deliver this evidence to the World Bank in a timely manner. DLR#1.3: All Targeted Training Institutions have addressed the capacity gaps identified in their respective Capacity Building Plans in FY 2016- Protocol: The same DLI protocol in 1.2 above will be applied to all of the training institutes enumerated in 1.1. Of special importance is evidence that the new curriculum is being delivered satisfactorily by all the institutes. The external verification firm will be responsible for gathering evidence while the MoH will deliver this evidence to the World Bank in a timely manner. Nurse and Midwifery Training Institutions Country wide/Integrated human resource information system (iHRIS) Data source/ Agency M&E Department in MoH and the Independent verification Agency Verification Entity Administer check list to the Nurse Midwifery Training Institutions and generates data from the integrated human resource Procedure information system (iHRIS) DLI_TBL_VERIFICATION PBC 2 Health workers trained in MNCH and nutrition competencies in the targeted provinces (Cumulative, Custom, DLI) Description Number of health workers trained in MNCH and nutrition competencies in the targeted provinces. 34 The World Bank Health Services Improvement Project (P145335) Training Institutions, Level-II Hospitals and Integrated Human Resource Information System (iHRIS) Data source/ Agency M&E Department in MoH and the independent verification Agency Verification Entity Administer checklist to the training institutions and Level-II Hospitals Generate data from the iHRIS Procedure DLI_TBL_VERIFICATION Number of vacancies for nurses and midwifes in primary health facilities filled by newly recruited nurses and midwifes who PBC 2 completed the 3-month induction in-service training on MNCH and nutrition DLI #2: The number of vacancies for nurses and midwifes in primary health facilities in Targeted Provinces filled by newly recruited nurses and midwifes who have completed the three (3) month induction in-service training on MNCH and nutrition increases. DLR#2.1: Consolidated staffing profiles for nurses and midwifes in primary health facilities in Targeted Provinces prepared in FY 2014 and training modules for the three (3) months induction in-service training on MNCH and nutrition for newly recruited nurses and midwifes developed. Protocol: (a) Staffing profiles for all health centers and health posts in targeted provinces will be presented as evidence. It will include the name and location of the health center/health post and the composition of all health professionals by name and title/grade. The staffing profiles will be dated no earlier than 31st December 2013. The profiles will also include the official the GRZ staff establishment by title, grade and number of staff that adheres to the GRZ staff establishment for the facility so that over-/under-staffing is readily apparent. These will be official Government profiles provided by the sanctioned HR system and vetted and approved by the Permanent Secretary Description MCDMCH. This information will be provided by PS-MCDMCH to the World Bank as evidence of compliance; (b) A three months in-service training course for new nurses and midwives will be developed by a joint team from MCDMCH and MOH and approved by PS - MCDMCH. The composition of the three months training course will include modules in MNCH and nutrition. The total time to be spent in this training should include theory and practical. The MCDMCH will be responsible for gathering and providing the requisite evidence to the World Bank. The value of the DLI will be divided such that 50% is paid for the profiles and 50% for the modules. DLR#2.2: At least 10% of the number vacancies for nurses and midwifes in primary health facilities in Targeted Provinces filled by newly recruited nurses and midwifes who have completed the three (3) month induction in-service training on MNCH and nutrition in FY 2016. Protocol: At least 10% of the vacancies for nurses and midwives identified in December 2013 in each targeted province will be filled as of 31st December 2015. To be satisfied, each province will need to meet the 10% standard. Payment of Bank funds for this sub-component will be pro-rated according to provinces meeting this standard. Data verifying the existing and filled vacancies will be taken from the staff returns for the year 2015 as of 31st 35 The World Bank Health Services Improvement Project (P145335) December 2015. In order to be counted as a ‘filled vacancy’ each of the new recruits must have completed the 3month training course. For those hired less than 3 months prior to the close of the 12month period it must be shown that they have begun the training module. The external verification firm will be responsible for gathering and vetting the requisite evidence, while the MCDMCH will provide this evidence to the World Bank in a satisfactory format. DLR#2.3: At least 20% of the number vacancies for nurses and midwifes in primary health facilities in Targeted Provinces filled by newly recruited nurses and midwifes who have completed the three (3) month induction in-service training on MNCH and nutrition in FY 2017 .Protocol: At least 20% of vacancies for nurses and midwives identified in December 2013 in each targeted province will be filled as of 31st December 2016. The protocol for statistical verification of recruits in the 12month period will be the same as in 2.2 above. DLR#2.4: At least 30% of the number vacancies for nurses and midwifes in primary health facilities in Targeted Provinces filled by newly recruited nurses and midwifes who have completed the three (3) month induction in-service training on MNCH and nutrition in FY 2018. Protocol: At least 30% of vacancies for nurses and midwives identified in December 2013 in each targeted province will be filled as of 31st December 2017. The protocol for statistical verification of recruits in the 12month period will be the same as in 2.2 above. DLR#2.5: At least 40% of the number vacancies for nurses and midwifes in primary health facilities in Targeted Provinces filled by newly recruited nurses and midwifes who have completed the three (3) month induction in-service training on MNCH and nutrition in FY 2019. Protocol: At least 40% of vacancies for nurses and midwives identified in December 2013 in each targeted province will be filled as of 31st December 2018. The protocol for statistical verification of recruits in the 12month period will be the same as in 2.2 above. Training Institutions, Level-II Hospitals and Integrated Human Resource Information System (iHRIS) Data source/ Agency M&E Department in MoH and the independent verification Agency Verification Entity Administer checklist to the training institutions and Level-II Hospitals Generate data from the iHRIS Procedure DLI_TBL_VERIFICATION Nurses and Midwives in primary health facilities in Targeted Provinces who have completed the continuing professional PBC 3 development (CPD) training in MNCH-N increases. DLI # 3: The number of nurses and midwives in primary health facilities in Targeted Provinces who have completed the Description continuing professional development training in MNCH and nutrition increases 36 The World Bank Health Services Improvement Project (P145335) DLR# 3.1: Training modules for the continuing professional development training in MNCH and nutrition developed in FY 2015. Protocol- “Developed” training modules means that the required knowledge and skills to provide quality MNCH and nutrition services have been identified, and modules prepared to address the identified gaps. These modules will be developed jointly by MoH and MCDMCH, and signed off by the PS-MCDMCH. The modules should outline the training methodologies (including e-learning, lectures through workshops and short courses, and study tours/exchange programmes etc), and implementation process through the Provincial Medical Office. Through the external verification firm, information will be gathered and provided to the MCDMCH who will be responsible for providing the requisite evidence to the World Bank in a satisfactory format. DLR# 3.2: At least 10% of the number of nurses and midwives in primary health facilities in Targeted Provinces have completed the continuing professional development training in MNCH and nutrition in FY 2016 Protocol - By 31st December 2015, at least 10% of the number of nurses and midwives in each of the targeted provinces has completed at least one of the CPD training modules. If a module is begun at the end of the year but not completed before the end of the 12 month period, the trainee will be counted but the Government must show that the course was completed in a timely manner in the subsequent year. To be satisfied, each province will need to meet the 10% standard. Payment of Bank funds for this sub-component will be pro-rated according to provinces meeting this standard. For the year under review, data verifying the number of nurses and midwives will be taken from the staff returns, and for the CPD training from Provincial Medical Offices in each of the targeted province. Through the external verification firm, information will be gathered and provided to the MCDMCH who will be responsible for providing the requisite evidence to the World Bank in a satisfactory format. DLR# 3.3: At least 20% of the number of nurses and midwives in primary health facilities in Targeted Provinces have completed the continuing professional development training in MNCH and nutrition in FY 2017. Protocol- By 31st December 2016, at least 20% of the number of nurses and midwives in each of the targeted provinces has completed at least one of the CPD training modules. The protocol for statistical verification of CPD training in the 12-month period will be the same as in 3.2 above. DLR# 3.4: At least 30% of the number of nurses and midwives in primary health facilities in Targeted Provinces have completed the continuing professional development training in MNCH and nutrition in FY 2018. Protocol - By 31st December 2017, at least 30% of the number of nurses and midwives in each of the targeted provinces has completed at least one of the CPD training modules. The protocol for statistical verification of CPD training in the 12-month period will be the same as in 3.2 above. DLR# 3.5: At least 40% of the number of nurses and midwives in primary health facilities in Targeted Provinces have completed the continuing professional development training in MNCH and nutrition in FY 2019. Protocol- By 31st December 2018, at least 40% of the number of nurses and midwives in each of the targeted provinces has completed at least one of 37 The World Bank Health Services Improvement Project (P145335) the CPD training modules. The protocol for statistical verification of CPD training in the 12-month period will be the same as in 3.2 above. Integrated Human Resource Information System (iHRIS); Nurse Training Institutions; Level 2&3 Hospitals Data source/ Agency M&E Department in MoH/ Independent Verification Agency Verification Entity Administer checklist to Training Institutions and generate data from the Integrated Human Resource Information System Procedure (iHRIS) DLI_TBL_VERIFICATION Number of nurses and midwives in primary health facilities in targeted provinces who have completed the continuing PBC 3 professional development training in MNCH and nutrition. DLI # 3: The number of nurses and midwives in primary health facilities in Targeted Provinces who have completed the continuing professional development training in MNCH and nutrition increases DLR# 3.1: Training modules for the Continuous Professional Development Training in MNCH and nutrition developed in FY 2015. Protocol- “Developed” training modules means that the required knowledge and skills to provide quality MNCH and nutrition services have been identified, and modules prepared to address the identified gaps. These modules will be developed jointly by MoH and MCDMCH and signed off by the PS-MCDMCH. The modules should outline the training methodologies (including e-learning, lectures through workshops and short courses, and study tours/exchange programmes etc), and implementation process through the Provincial Medical Office. Through the external verification firm, information will be gathered and provided to the MCDMCH who will be responsible for providing the requisite evidence to the World Description Bank in a satisfactory format. DLR# 3.2: At least 10% of the number of nurses and midwives in primary health facilities in Targeted Provinces have completed the Continuous Professional Development Training in MNCH and nutrition in FY 2016. Protocol - By 31st December 2015, at least 10% of the number of nurses and midwives in each of the targeted provinces has completed at least one of the CPD training modules. If a module is begun at the end of the year but not completed before the end of the 12 month period, the trainee will be counted but the Government must show that the course was completed in a timely manner in the subsequent year. To be satisfied, each province will need to meet the 10% standard. Payment of Bank funds for this sub-component will be pro-rated according to provinces meeting this standard. For the year under review, data verifying the number of nurses and midwives will be taken from the staff returns, and for the CPD training from Provincial Medical Offices in each of the targeted province. Through the external verification firm, information will be gathered and 38 The World Bank Health Services Improvement Project (P145335) provided to the MCDMCH who will be responsible for providing the requisite evidence to the World Bank in a satisfactory format. DLR# 3.3: At least 20% of the number of nurses and midwives in primary health facilities in Targeted Provinces have completed the continuing professional development training in MNCH and nutrition in FY 2017. Protocol- By 31st December 2016, at least 20% of the number of nurses and midwives in each of the targeted provinces has completed at least one of the CPD training modules. The protocol for statistical verification of CPD training in the 12-month period will be the same as in 3.2 above. DLR# 3.4: At least 30% of the number of nurses and midwives in primary health facilities in Targeted Provinces have completed the Continuous Professional Development Training in MNCH and nutrition in FY 2018. Protocol - By 31st December 2017, at least 30% of the number of nurses and midwives in each of the targeted provinces has completed at least one of the CPD training modules. The protocol for statistical verification of CPD training in the 12-month period will be the same as in 3.2 above. DLR# 3.5: At least 40% of the number of nurses and midwives in primary health facilities in Targeted Provinces have completed the Continuous Professional Development Training in MNCH and nutrition in FY 2019. Protocol- By 31st December 2018, at least 40% of the number of nurses and midwives in each of the targeted provinces has completed at least one of the CPD training modules. The protocol for statistical verification of CPD training in the 12-month period will be the same as in 3.2 above. Integrated Human Resource Information System (iHRIS); Nurse Training Institutions; Level 2&3 Hospitals Data source/ Agency M&E Department in MoH/ Independent Verification Agency Verification Entity Administer checklist to Training Institutions and generate data from the Integrated Human Resource Information System Procedure (iHRIS) DLI_TBL_VERIFICATION PBC 4 Primary health facilities in Targeted Provinces stocked with all tracer drugs increases DLI #4: The number of primary health facilities in Targeted Provinces stocked with all tracer drugs increases DLR#4.1: A national supply chain strategy adopted in FY 2014. Protocol: A supply chain strategy developed by December Description 2014 and signed by Permanent Secretary MoH. The Strategy developed with wider consultation of stakeholders. Once adopted by the Government, the Strategy to posted on the MOH website and disseminated. 39 The World Bank Health Services Improvement Project (P145335) DLR#4.2: A baseline survey carried out to establish the number of primary health facilities in the Targeted Provinces with all tracer drugs in FY 2015. Protocol: A baseline health facility survey will be carried out by MoH/MSL in the targeted provinces to establish the availability of tracer drugs. The tracer drugs will include Oxytocin, Iron Folic Acid tablets, Sulfadoxine- Pyrimethamine (for IPT), Vitamin A, Oral Rehydration Salt, Pentavalent vaccine and Depo-Provera/Norplant. The MoH will develop a proposal and concept note outlining the methodology, resources to be used, and time frame. The independent external verification firm will be responsible for gathering and substantiation of evidence that this DLI has been met. The PS- MoH shall submit to the World Bank, a final report with results and recommendations from the study and final verdict on the attainment of this DLI as provided by the independent external verification firm. DLR#4.3: The number of primary health facilities in Targeted Provinces project area stocked with all tracer drugs increases by 5% from the Baseline in FY 2016. Protocol: A 5% increase the number of primary health facilities with all tracer drugs achieved by 31st December 2015 in each of the targeted provinces as identified from the baseline survey results in 4.2 above. To be satisfied, each province will need to meet the 5% standard. Payment of Bank funds for this sub-component will be pro-rated according to provinces meeting this standard. Through the external verification firm, information will be gathered and provided to the MoH who will be responsible for providing the requisite evidence to the World Bank. DLR#4.4: The number of primary health facilities in Targeted Provinces project area stocked with all tracer drugs increases by 10% from the Baseline in FY 2017. Protocol: A 10% increase the number of primary health facilities with all tracer drugs achieved by 31st December 2016 in each of the targeted provinces as identified from the baseline survey results in 4.2 above. The protocol for statistical verification of increases in the tracer drugs stock in the 12-month period will be the same as in 4.3 above. DLR#4.5: The number of primary health facilities in Targeted Provinces project area stocked with all tracer drugs increases by 15% from the Baseline in FY 2018. Protocol: A 15% increase the number of primary health facilities with all tracer drugs achieved by 31st December 2017 in each of the targeted provinces as identified from the baseline survey results in 4.2 above. The protocol for statistical verification of increases in the tracer drugs stock in the 12- month period will be the same as in 4.3 above. DLR#4.6: The number of primary health facilities in Targeted Provinces project area stocked with all tracer drugs increases by 20% from the Baseline in FY 2019. Protocol: A 20% increase the number of primary health facilities with all tracer drugs achieved by 31st December 2018 in each of the targeted provinces as identified from the baseline survey results in 4.2 above. The protocol for statistical verification of increases in the tracer drugs stock in the 12-month period will be the same as in 4.3 above. 40 The World Bank Health Services Improvement Project (P145335) District Health Management Team (DHMT) Records Data source/ Agency M&E Department in MoH and Independent Verification Agency Verification Entity Health Facility Survey Procedure DLI_TBL_VERIFICATION PBC 4 Number of primary health facilities in targeted provinces stocked with all tracer drugs DLI #4: The number of primary health facilities in Targeted Provinces stocked with all tracer drugs increases DLR#4.1: A national supply chain strategy adopted in FY 2014. Protocol: A supply chain strategy developed by December 2014 and signed by Permanent Secretary MoH. The Strategy developed with wider consultation of stakeholders. Once adopted by the Government, the Strategy to posted on the MOH website and disseminated. DLR#4.2: A baseline survey carried out to establish the number of primary health facilities in the Targeted Provinces with all tracer drugs in FY 2015. Protocol: A baseline health facility survey will be carried out by MoH/MSL in the targeted provinces to establish the availability of tracer drugs. The tracer drugs will include Oxytocin, Iron Folic Acid tablets, Sulfadoxine- Pyrimethamine (for IPT), Vitamin A, Oral Rehydration Salt, Pentavalent vaccine and Depo-Provera/Norplant. The MoH will develop a proposal and concept note outlining the methodology, resources to be used, and time frame. The independent external verification firm will be responsible for gathering and substantiation of evidence that this DLI has been met. The PS- MoH shall submit to the World Bank, a final report with results and recommendations from the study and final verdict on Description the attainment of this DLI as provided by the independent external verification firm. DLR#4.3: The number of primary health facilities in Targeted Provinces project area stocked with all tracer drugs increases by 5% from the Baseline in FY 2016. Protocol: A 5% increase the number of primary health facilities with all tracer drugs achieved by 31st December 2015 in each of the targeted provinces as identified from the baseline survey results in 4.2 above. To be satisfied, each province will need to meet the 5% standard. Payment of Bank funds for this sub-component will be pro-rated according to provinces meeting this standard. Through the external verification firm, information will be gathered and provided to the MoH who will be responsible for providing the requisite evidence to the World Bank. DLR#4.4: The number of primary health facilities in Targeted Provinces project area stocked with all tracer drugs increases by 10% from the Baseline in FY 2017. Protocol: A 10% increase the number of primary health facilities with all tracer drugs achieved by 31st December 2016 in each of the targeted provinces as identified from the baseline survey results in 4.2 above. The protocol for statistical verification of increases in the tracer drugs stock in the 12-month period will be the same as in 4.3 above. 41 The World Bank Health Services Improvement Project (P145335) DLR#4.5: The number of primary health facilities in Targeted Provinces project area stocked with all tracer drugs increases by 15% from the Baseline in FY 2018. Protocol: A 15% increase the number of primary health facilities with all tracer drugs achieved by 31st December 2017 in each of the targeted provinces as identified from the baseline survey results in 4.2 above. The protocol for statistical verification of increases in the tracer drugs stock in the 12- month period will be the same as in 4.3 above. DLR#4.6: The number of primary health facilities in Targeted Provinces project area stocked with all tracer drugs increases by 20% from the Baseline in FY 2019. Protocol: A 20% increase the number of primary health facilities with all tracer drugs achieved by 31st December 2018 in each of the targeted provinces as identified from the baseline survey results in 4.2 above. The protocol for statistical verification of increases in the tracer drugs stock in the 12-month period will be the same as in 4.3 above. District Health Management Team (DHMT) Records Data source/ Agency M&E Department in MoH and Independent Verification Agency Verification Entity Health Facility Survey Procedure DLI_TBL_VERIFICATION PBC 5 Regional hubs and staging posts equipped countrywide (Cumulative, Custom, DLI) Description Number regional hubs and staging posts equipped in target areas. Medical Stores Limited Records Data source/ Agency M&E Department in MoH/Independent Verification Agency Verification Entity Administer Checklist to Medical Stores Limited (MSL) Procedure DLI_TBL_VERIFICATION PBC 5 Number of Regional essential commodities storage and distribution hubs established DLI #5: Regional essential commodities storage and distribution hubs established in Targeted Provinces Description DLR#5.1: The regional essential commodities storage and distribution hub for Western Province established at Mongu in FY 2014. Protocol: “Established” means that by the end of 2014 there is a hub already functioning for at least one month, with 42 The World Bank Health Services Improvement Project (P145335) infrastructure, management information system, transport, staffing, adequate essential drugs stock levels; and essential drugs being delivered to primary health facilities in its region. The M)H in collaboration with Medical Stores Limited and other key stakeholders will conduct a verification mission to gather evidence on the attainment of this DLI. A standard checklist (Annex 12) will be used during the verification process. This checklist will include key evaluation questions on progress made in the areas of infrastructure, transport, staffing, availability of essential drugs, and extent to which drugs are being delivered to the primary health facilities. Based on the findings of the verification mission, the MOH will produce and submit to the World Bank, a report with evidence on the level of accomplishment. DLR#5.2: The regional essential commodities storage and distribution hub for the North-Western Province established at Kitwe in FY 2015. Protocol: By the end of 31st December 2015, the regional essential commodities storage and distribution hub for the North-Western Province will be established in Kitwe. The protocol outlined in 5.1 above will apply. Through the external verification firm, information will be gathered and provided to the MOH who will be responsible for providing the requisite evidence to the World Bank. DLR#5.3: The regional essential commodities storage and distribution hub for the Northern Province established at Kasama in FY 2016. Protocol: By the end of 31st December 2016, the regional essential commodities storage and distribution hub for the Northern Province will be established in Kasama. The protocol outlined in 5.1 above will apply. Through the external verification firm, information will be gathered and provided to the MOH who will be responsible for providing the requisite evidence to the World Bank. Medical Stores Limited Records Data source/ Agency M&E Department in MoH/Independent Verification Agency Verification Entity Administer Checklist to Medical Stores Limited (MSL) Procedure DLI_TBL_VERIFICATION PBC 6 The electronic Zambia Inventory Control System (eZICS) is piloted and implemented in Targeted Provinces DLI #6: The electronic Zambia Inventory Control System (eZICS) is piloted and implemented in Targeted Provinces DLR# 6.1: MOH adopts an implementation plan for the national supply chain strategy in FY 2014. Protocol: “Adopts” means Description that the plan is officially approved by PS-MOH and circulated for use by all stakeholders in the health sector. The implementation plan should be aligned to the national supply chain strategy with clear objectives and targets, timelines, 43 The World Bank Health Services Improvement Project (P145335) financial and other resourcing needs, gaps and how these will be addressed. The MoH will post the final implementation plan on the MoH website, and shall submit to the World Bank, a copy of this plan. DLR# 6.2: The eZICS is piloted in selected Districts and upgraded on the basis of the results of the pilots in FY 2015. Protocol: “Piloted” means that eZICS is implemented in Mkushi and Kafui districts by 31st December 2015 and used by individuals trained for this purpose for a period deemed sufficient to evaluate the success of eZICS and identify problems that need to be rectified for a successful roll out and implementation of the program. A report covering each of the pilots will be prepared indicating problems and successes, and remedial measures. Compliance will require that the Government demonstrate that it has corrected important problems and is ready for roll-out. Through the external verification firm, evidence on the implementation of the eZICS will be gathered and provided to the MoH who will be responsible for providing the requisite evidence to the World Bank. DLR# 6.3: The eZICS is implemented in Western and North Western Provinces in FY 2016. Protocol: By 31st December 2016, the eZICS is implemented in Western and North Western Provinces, for at least one quarter. “…implemented” means that members of staff are adequately trained, software and hardware procured, system set up, and results being generated. Through the external verification firm, evidence on the implementation of the eZICS will be gathered and provided to the MoH who will be responsible for providing the requisite evidence to the World Bank. DLR# 6.4: The eZICS is implemented in Muchinga and Northern Provinces in FY 2017. Protocol: By 31st December 2017, eZICS is implemented in Muchinga and Northern Provinces for at least one quarter. “…implemented” means that members of staff are adequately trained, software and hardware procured, system set up, and results being generated. Through the external verification firm, evidence on the implementation of the eZICS will be gathered and provided to the MoH who will be responsible for providing the requisite evidence to the World Bank. DLR# 6.5: The eZICS is implemented in Luapula Province in FY 2018. Protocol:By 31st December 2018, eZICS is implemented in Luapula Province for at least one quarter. “…implemented” means that members of staff are adequately trained, software and hardware procured, system set up, and results being generated. Through the external verification firm, evidence on the implementation of the eZICS will be gathered and provided to the MoH who will be responsible for providing the requisite evidence to the World Bank. DHMT/MSL records Data source/ Agency M&E Department in MoH Verification Entity 44 The World Bank Health Services Improvement Project (P145335) Administer Checlist to DHMTs and MSL. Procedure DLI_TBL_VERIFICATION PBC 6 The electronic Zambia Inventory Control System (eZICS) is piloted and implemented in targeted provinces DLI #6: The electronic Zambia Inventory Control System (eZICS) is piloted and implemented in Targeted Provinces DLR# 6.1: MOH adopts an implementation plan for the national supply chain strategy in FY 2014. Protocol: “Adopts” means that the plan is officially approved by PS-MOH and circulated for use by all stakeholders in the health sector. The implementation plan should be aligned to the national supply chain strategy with clear objectives and targets, timelines, financial and other resourcing needs, gaps and how these will be addressed. The MoH will post the final implementation plan on the MoH website, and shall submit to the World Bank, a copy of this plan. DLR# 6.2: The eZICS is piloted in selected Districts and upgraded on the basis of the results of the pilots in FY 2015. Protocol: “Piloted” means that eZICS is implemented in Mkushi and Kafui districts by 31st December 2015 and used by individuals trained for this purpose for a period deemed sufficient to evaluate the success of eZICS and identify problems that need to be rectified for a successful roll out and implementation of the program. A report covering each of the pilots will be prepared indicating problems and successes, and remedial measures. Compliance will require that the Government demonstrate that it has corrected important problems and is ready for roll-out. Through the external verification firm, evidence on the implementation of the eZICS will be gathered and provided to the MoH who will be responsible for Description providing the requisite evidence to the World Bank. DLR# 6.3: The eZICS is implemented in Western and North Western Provinces in FY 2016. Protocol: By 31st December 2016, the eZICS is implemented in Western and North Western Provinces, for at least one quarter. “…implemented” means that members of staff are adequately trained, software and hardware procured, system set up, and results being generated. Through the external verification firm, evidence on the implementation of the eZICS will be gathered and provided to the MoH who will be responsible for providing the requisite evidence to the World Bank. DLR# 6.4: The eZICS is implemented in Muchinga and Northern Provinces in FY 2017. Protocol: By 31st December 2017, eZICS is implemented in Muchinga and Northern Provinces for at least one quarter. “…implemented” means that members of staff are adequately trained, software and hardware procured, system set up, and results being generated. Through the external verification firm, evidence on the implementation of the eZICS will be gathered and provided to the MoH who will be responsible for providing the requisite evidence to the World Bank. DLR# 6.5: The eZICS is implemented in Luapula Province in FY 2018. Protocol:By 31st December 2018, eZICS is implemented in Luapula Province for at least one quarter. “…implemented” means that members of staff are adequately trained, software and hardware procured, system set up, and results being generated. Through the external verification 45 The World Bank Health Services Improvement Project (P145335) firm, evidence on the implementation of the eZICS will be gathered and provided to the MoH who will be responsible for providing the requisite evidence to the World Bank. DHMT/MSL records Data source/ Agency M&E Department in MoH Verification Entity Administer Checlist to DHMTs and MSL. Procedure DLI_TBL_VERIFICATION PBC 7 Women attending ANC within the first three months of Pregnancy in the project areas (Custom, DLI) Numerator: Number of women attending ANC within the first three months of Pregnancy in the project areas multiply by Description 100 Denominator: Total number expected pregnancies in project areas DHIS-2 Data source/ Agency M&E Department in MoH and Independent Verification Agency Verification Entity Generate data from the Health Management Information System Procedure DLI_TBL_VERIFICATION PBC 7 Number of women registered during the first trimester of their pregnancy in targeted provinces DLI #7: The number of women registered during the first trimester of their pregnancy in targeted Provinces increases DLR#7.1: An updated community health workers strategy adopted and disseminated in FY 2014. Protocol: The community health strategy will contain time-bound objectives, coverage and other targets governing resourcing and staffing at community level, community service delivery modes, and links to health facilities. The strategy should cover all the structures and cadres operating at community level in all the three (3) functions namely: (i) Community development, (ii) Description Social Welfare, and (iii) Health. “Adopted” means that the plan is discussed by all stakeholders, and officially approved by PS-MCDMCH. “Disseminated” means that the approved plan has been formally circulated for use by all stakeholders in the health sector. The MCDMCH will submit the final community health strategy to the World Bank. DLR#7.2: Guidelines for the delivery of community based MNCH and nutrition services adopted in FY 2015. Protocol: (a) By 31st December 2015, guidelines for the delivery of community based MNCH and nutrition services will be adopted. 46 The World Bank Health Services Improvement Project (P145335) “…adopted” means that the guidelines are developed in consultation with all stakeholders, and officially approved by the PS-MCDMCH. These guidelines should be aligned to the national community health strategy with clear objectives and targets. Through the external verification firm, evidence will be gathered while the PS-MCDMCH will be responsible for submitting evidence to the World Bank(a) By 31st December 2015, guidelines for the delivery of community-based MNCH and nutrition services will be adopted. “…adopted” means that the guidelines are developed in consultation with all stakeholders, and officially approved by the PS-MCDMCH. These guidelines should be aligned to the national community health strategy with clear objectives and targets. Through the external verification firm, evidence will be gathered while the PS-MCDMCH will be responsible for submitting evidence to the World Bank. DLR#7.3: The number of women registered during the first trimester of their pregnancy in targeted Provinces increases by 5% in FY 2016. Protocol: To facilitate the process of generating data for 7.3-7.6, MCDMCH in collaboration with MoH will collect data on the number of women registered during the first trimester of their pregnancy in all the targeted Provinces as at 31st December 2014 through a desk review of HMIS data or a health facility survey. By 31st December 2015, the number of women registered during the first trimester of their pregnancy in each of the targeted Provinces increases by 5% over the provincial baseline of December 2014. To be satisfied, each province will need to meet the 5% standard. Payment of Bank funds for this sub-component will be pro-rated according to provinces meeting this standard. Through the external verification firm, evidence will be gathered while the PS-MCDMCH will be responsible for submitting evidence to the World Bank. DLR#7.4: The number of women registered during the first trimester of their pregnancy in targeted Provinces increases by 10% in FY 2017. Protocol: By 31st December 2016, the number of women registered during the first trimester of their pregnancy in all each of the targeted Provinces increases by 10% over the provincial baseline of December 2014. The protocol for statistical verification of this DLI in the 12month period will be the same as in 7.3 above. DLR#7.5: The number of women registered during the first trimester of their pregnancy in targeted Provinces increases by 15% in FY 2018. Protocol: By 31st December 2017, the number of women registered during the first trimester of their pregnancy in all each of the targeted Provinces increases by 15% over the provincial baseline of December 2014. The protocol for statistical verification of this DLI in the 12 month period will be the same as in 7.3 above DLR#7.6: The number of women registered during the first trimester of their pregnancy in targeted Provinces increases by 20% in FY 2019. Protocol: By 31st December 2018, the number of women registered during the first trimester of their pregnancy in all each of the targeted Provinces increases by 20% over the provincial baseline of December 2014. The protocol for statistical verification of this DLI in the 12 month period will be the same as in 7.3 above 47 The World Bank Health Services Improvement Project (P145335) DLR 7.7: The number of women registered during the first trimester of their pregnancy in targeted Provinces increases by 1 percentage point. Protocol: 18,900 SDR for every 1 percentage point increase from the baseline in the number of women registered during the first trimester of their pregnancy in targeted provinces by June 30, 2020. District Health Management Information System -2 (DHIS-2) Data source/ Agency M&E Department in MoH and Independent Verification Agency Verification Entity Generate data from the Health Management Information System Procedure DLI_TBL_VERIFICATION PBC 8 Lactating women accessing post-natal care within six days in the project areas (Custom, DLI) Numerator: Number of lactating women accessing post-natal care within six days in the project areas multiply by 100 Description Denominator: Total number of institutional deliveries at health facilities in project areas DHIS-2 Data source/ Agency M&E Department in MoH/ Independent Verification Agency Verification Entity Generate data from the Health Management Information System Procedure DLI_TBL_VERIFICATION PBC 8 Number of mothers who delivered at health facilities in targeted provinces and who received post-natal care DLI #8: The number of mothers who delivered at health facilities in Targeted Provinces and who received post-natal care increases DLR#8.1: The list of CHWs, Neighborhood Health Committees and Outreach Centers updated in FY 2014. Protocol: For Description targeted provinces an updated list of all CHWs, Neighborhood Health Committees and Outreach Centers will be generated as at 31st December 2013. The MCDMCH will develop detailed data collection tools that will be used to this information at each Health Centre and/or Health Post in all the districts in the five (5) targeted provinces. This will include information on 48 The World Bank Health Services Improvement Project (P145335) the catchment population for the health centre/health post; number of households; number of outreach posts, zones and distances to health centre; types and numbers of community organizations attached to each health centre; membership to the community level organizations; number of CHWs; number of hours, on average, the CHW spend in communities per week etc. The PS-MCDMCH will provide the updated list to the Bank. DLR#8.2: The Recipient acquires adequate numbers of ambulances and motorcycles for facilitating patient referrals in targeted Provinces in FY 2015. Protocol: Each province will acquire a number of ambulances and motorcycles adequate for facilitating patient referrals. The number and distribution of this equipment will be predetermined in a report/document agreed by the Bank and Government by October 2015. Through the external verification firm, evidence will be gathered while the PS-MCDMCH will be responsible for submitting evidence to the World Bank. DLR#8.3: The number of mothers who delivered at health facilities in Targeted Provinces and who received post-natal care increases by 5% in FY 2016. Protocol: To facilitate the process of generating data for 8.3-8.6, MCDMCH in collaboration with MOH will collect data on the number of mothers who delivered at health facilities in Targeted Provinces and who received post-natal care as at 31st December 2014 through a desk review of HMIS data or a health facility survey. By 31st December 2015, the number of mothers who delivered at health facilities and who received post-natal care in each of the targeted Provinces increases by 5% over the provincial baseline of December 2014. “Post-natal care” is defined as the number of Post-natal care (visits) at 6 days. The number of mothers delivering will have increased by 5% in each province. Payment of Bank funds for this sub-component will be pro-rated according to provinces meeting this standard. “Post-natal care” that is begun at the end of the period but not completed will be counted as completed for purposes of disbursement but in the subsequent period authorities will need to indicate that it was completed on a case by case basis. Through the external verification firm, evidence will be gathered while the PS-MCDMCH will be responsible for submitting evidence to the World Bank. DLR#8.4: The number of mothers who delivered at health facilities in Targeted Provinces and who received post-natal care increases by 7% in FY 2017. Protocol: By 31st December 2016, the number of mothers who delivered at health facilities and who received post-natal care in each of the targeted Provinces increases by 7% over the provincial baseline of December 2014. The protocol for statistical verification of this DLI in the 12month period will be the same as in 8.3 above. DLR#8.5: The number of mothers who delivered at health facilities in Targeted Provinces and who received post-natal care increases by 10 % in FY 2018. Protocol: By 31st December 2017, the number of mothers who delivered at health facilities and who received post-natal care in each of the targeted Provinces increases by 10% over the provincial baseline of December 2014. The protocol for statistical verification of this DLI in the 12month period will be the same as in 8.3 above. DLR#8.6: The number of mothers who delivered at health facilities in Targeted Provinces and who received post-natal care increases by 15 % in FY 2019. Protocol: By 31st December 2018, the number of mothers who delivered at health facilities 49 The World Bank Health Services Improvement Project (P145335) and who received post-natal care in each of the targeted Provinces increases by 15% over the provincial baseline of December 2014. The protocol for statistical verification of this DLI in the 12month period will be the same as in 8.3 above. DLR 8.7: The number of mothers who received post-natal care within 6 days of delivery in targeted provinces by 1 percentage point. Protocol: 32,000 SDR for every 1 percentage point increase from the baseline in the number of mothers who received post-natal care within 6 days of delivery in targeted provinces by June 30, 2020 District Health Management Information System-2 (DHIS-2) Data source/ Agency M&E Department in MoH/ Independent Verification Agency Verification Entity Generate data from the Health Management Information System Procedure DLI_TBL_VERIFICATION Outreach sites in targeted provinces conducting GMP based on new standard guidelines in the project areas (Cumulative, PBC 9 Custom, DLI) Description Outreach sites in targeted provinces conducting GMP based on new standard guidelines in the project areas. District Health Management Team (DHMT) Records Data source/ Agency M&E Department in MoH and Independent Verification Agency Verification Entity Administer Checklist to DHMTs Procedure DLI_TBL_VERIFICATION PBC 9 Number of Outreach Sites in targeted provinces conducting GMP based on new standard guidelines in the project areas DLI #9: The number of Outreach Centers in Targeted Provinces conducting GMP monitoring following national standards and guidelines increases DLR# 9.1: Guidelines for conducting GMP monitoring adopted in FY 2014. Protocol: The guidelines for conducting GMP Description monitoring will contain clear objectives and targets, and service delivery modes and linkages at both health facility and community levels. The guidelines should be developed through a consultative process with all stakeholders and must cover all the key areas outlined in the national nutrition policy, the National Food and Nutrition Strategic Plan, as well as the “Scaling Up Nutrition” (SUN) first 1,000 days programme. “Adopted” means that the Guidelines are officially approved by 50 The World Bank Health Services Improvement Project (P145335) the PS-MCDMCH. The approved Guidelines should also have been formally circulated for use by all stakeholders in the health sector. The MCDMCH will submit the final document to the World Bank. DLR# 9.2: Checklists and protocols for the supervision of GMP monitoring at different service delivery levels adopted in FY 2015. Protocol: By 31st December 2015, checklists and protocols for the supervision of GMP monitoring at different service delivery levels will have been adopted. “…adopted” means that the checklists and protocols for the supervision of GMP monitoring are developed in consultation with all stakeholders, and officially approved by the PS-MCDMCH. These checklists and protocols should be aligned to the Guidelines for conducting GMP monitoring. Through the external verification firm, evidence will be gathered to ascertain the level of accomplishment while the PS-MCDMCH will submit the evidence to the World Bank. D.LR# 9.3: The number of Outreach Centers in targeted Provinces conducting GMP monitoring following national standards and guidelines increases by 10% in FY 2016. Protocol: To facilitate the process of generating data for 9.3-9.6, MCDMCH in collaboration with MOH will collect data on the number of Outreach Centers in targeted Provinces conducting GMP monitoring following national standards and guidelines as at 31st December 2014 through a desk review or a health facility survey. By 31st December 2015, the number of numbers of Outreach Centers conducting GMP monitoring following national standards and guidelines in each of the targeted Provinces increases by 10% over the provincial baseline of December 2014 in each province. Payment of Bank funds for this sub-component will be pro-rated according to provinces meeting this standard. Through the external verification firm, evidence will be gathered while the PS-MCDMCH will be responsible for submitting evidence to the World Bank. DLR# 9.4: The number of Outreach Centers in Targeted Provinces conducting GMP monitoring following national standards and guidelines increases by 20% in FY 2017. Protocol: By 31st December 2016, the number of Outreach Centers in targeted Provinces conducting GMP monitoring following national standards and guidelines increases 20% over the provincial baseline of December 2014. The protocol for statistical verification of this DLI in the 12month period will be the same as in 9.3 above. DLR# 9.5: The number of Outreach Centers in Targeted Provinces conducting GMP monitoring following national standards and guidelines increases by 30% in FY 2018. Protocol: By 31st December 2017, the number of Outreach Centers in targeted Provinces conducting GMP monitoring following national standards and guidelines increases 30% over the provincial baseline of December 2014. The protocol for statistical verification of this DLI in the 12month period will be the same as in 9.3 above DLR# 9.6: The number of Outreach Centers in targeted Provinces conducting GMP monitoring following national standards and guidelines increases by 40% in FY 2019. Protocol: By 31st December 2018, the number of Outreach Centers in targeted Provinces conducting GMP monitoring following national standards and guidelines increases 40% over the provincial 51 The World Bank Health Services Improvement Project (P145335) baseline of December 2014. The protocol for statistical verification of this DLI in the 12month period will be the same as in 9.3 above. DLR# 9.7: One percentage increase of Outreach Centers in targeted provinces conducting GMP following the revised national GMP standards and guidelines in calendar year 2019. Protocol: 48,000 SDR for every 1 percentage point increase of Outreach Centers in targeted provinces conducting GMP following the revised national GMP standards and guidelines by June 30, 2020. District Health Management Team (DHMT) Records Data source/ Agency M&E Department in MoH and Independent Verification Agency Verification Entity Administer Checklist to DHMTs Procedure 52 The World Bank Health Services Improvement Project (P145335)