The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) REPORT NO.: RES30306 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF BENIN MULTISECTORAL FOOD HEALTH NUTRITION PROJECT APPROVED ON DECEMBER 19, 2013 TO MINISTRY OF ECONOMY AND FINANCE HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Makhtar Diop Country Director: Pierre Frank Laporte Senior Global Practice Director: Timothy Grant Evans Practice Manager/Manager: Gaston Sorgho Task Team Leader: Menno Mulder-Sibanda, Jenny R. Gold i The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) ABBREVIATIONS AND ACRONYMS GAN Nutritional Care Group MAM Moderate Acute Malnutrition or Malnutrition Aigüe Modérée PECMAC Management of Acute Community-Based Malnutrition or Prise en Charge de la Malnutrition Aigüe à base Communautaire PDO Project Development Objective PMASN Multisectoral Food Health Nutrition Project SANC Community-based Health, Food and Nutrition or Sante, Alimentation et Nutrition à base Communautaire SP CAN Permanent Secretariat of the National Food and Nutrition Council or Secrétariat Permanent du Conseil de l’Alimentation et de la Nutrition CCC Multisectoral Coordination Platform or Cadre Communal de Concertation ii The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) BENIN MULTISECTORAL FOOD HEALTH AND NUTRITION PROJECT CONTENTS Page I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING……………………………………………………………………………………1 II. DESCRIPTION OF PROPOSED CHANGES……………………………………………………………………………………………………………….1 III. SUMMARY OF CHANGES……………………………………………………………………………………………………………………………………. 2 IV. DETAILED CHANGES…………………………………………………………………………………………………………………………………………….3 ANNEX 1: RESULTS FRAMEWORK AND MONITORING………………………………………………………………………………………………………9 iii The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) BASIC DATA Product Information Project ID Financing Instrument P143652 Investment Project Financing Original EA Category Current EA Category Not Required (C) Not Required (C) Approval Date Current Closing Date 19-Dec-2013 31-Jul-2019 Organizations Borrower Responsible Agency Secretariat Permanent du Conseil de l'Alimentation et de Republic of Benin la Nutrition Project Development Objective (PDO) Original PDO The development objective of the new project is to increase the coverage and utilization of community-based child growth andnutrition interventions in selected areas in the Recipient’s territory. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-53370 19-Dec-2013 11-Feb-2014 08-Apr-2014 31-Jul-2019 28.00 17.00 8.99 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No iv The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. PROJECT STATUS 1. The Multisectoral Food Health Nutrition Project (PMASN) is on track to meet its Project Development Objective (PDO), and progress is only accelerating as the project moves toward its final year. Disbursement also is on track, doubling from 29% to 65% in the last year. The project is expected to fully disburse by the July 2019 Closing Date. Further, the project will very likely exceed many of the targets for the results indicators because of the increasing intensity of the nutritional services now being delivered in communities and the extensive work done in the earlier years of the project to reinforce these services, and overcome initial delays. 2. Notably, Component 1, Policy and Program Development, and Management and Coordination has institutionalized the multisectoral coordination of nutrition policies and programs with strong government leadership, and Component 2, Community Mobilization and Service Delivery Strengthening has expanded the coverage of community-based nutrition and growth promotion services for young children across over 50% of the country. The community-based services are fully active in 40 out of the nation’s 77 districts or Communes1, and currently reach about 82% of young children in these areas. Moreover, all 77 Communes have planned nutritional activities in the new generation of their Development Plans (PDC) to ensure countrywide spillover of the project’s benefits. The 40 Communes in the project have also established multisectoral coordination platforms (i.e., “Cadre Communal de Concertation” or CCC) to deliver the nutrition and child growth promotion services. B. RATIONALE FOR RESTRUCTURING 3. The rationale of the proposed restructuring is to make minor improvements to the Results Framework (RF) to better capture the project’s contribution to the expansion of the community-based nutritional services at the Commune level. The main change is the addition of one PDO indicator to better assess the coverage of the expanded community-based services. There are also minor revisions to several of the intermediate indicators. 1 Benin is subdivided in 12 administrative regions (Département) and 77 districts (communes). The districts are local authorities with legal status and financial autonomy and are governed freely by an elected council. The Mayor is the head of the district. 1 The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) II. DESCRIPTION OF PROPOSED CHANGES C. RESULTS FRAMEWORK 4. At the PDO level, the project will add one indicator to help to assess the coverage of the expanded community- based nutritional and growth promotion services attributed to the project. The project will now monitor the indicator “Nutritional Care Group (GAN) members in place for delivering community-based services (number)”. This indicator assesses the coverage of GAN to deliver services in villages, outside facility structures. The GAN network being developed through the project is critical for long-term establishment of nutrition and growth promotion services in villages. Currently, one GAN member covers about 17 households and this ratio is expected to improve to further extend coverage to remote areas. 5. The following changes will be made to the intermediate outcome indicators: (a) Indicator number 5 is revised to reduce the target for number of households having established a hand washing stations, from 15,000 to 10,000, since handwashing stations are often established in shared areas in villages, rather than at the level of each household. (b) Indicator number 7 is revised to specifically measure the participation of women with children under 5 and pregnant women in education sessions, given that these are the key beneficiary groups for the project, rather than the general population. (c) Indicator number 9 is revised to specifically track the training of GAN, given the project’s reinforcement of the GAN to deliver services. (d) The project will also delete outdated Core Sector Indicators and replace them with the new Corporate Results Indicators. The above-mentioned changes do not affect the scope of the project and don’t change the expected project outcomes. III. SUMMARY OF CHANGES Changed Not Changed Change in Results Framework ✔ Change in Implementing Agency ✔ Change in DDO Status ✔ Change in Project's Development Objectives ✔ Change in Components and Cost ✔ Change in Loan Closing Date(s) ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Change in Disbursements Arrangements ✔ Change in Disbursement Estimates ✔ 2 The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) Change in Overall Risk Rating ✔ Change in Safeguard Policies Triggered ✔ Change of EA category ✔ Change in Legal Covenants ✔ Change in Institutional Arrangements ✔ Change in Financial Management ✔ Change in Procurement ✔ Change in Implementation Schedule ✔ Other Change(s) ✔ Change in Economic and Financial Analysis ✔ Change in Technical Analysis ✔ Change in Social Analysis ✔ Change in Environmental Analysis ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_RESULTS_TABLE RESULTS FRAMEWORK Project Development Objective Indicators PDO_IND_TABLE Children 0-23 months who benefit from a minimum package of monthly community-based growth promotion activities in targeted Communes Unit of Measure: Percentage Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 59.05 25.00 No Change Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Women with under-five children trained and engaged in the production and transformation of diversified and nutrient-rich foods Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 352.00 9000.00 No Change 3 The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Children 0-5 months who are exclusively breastfed in targeted Communes Unit of Measure: Percentage Indicator Type: Custom Baseline Actual (Current) End Target Action Value 33.00 41.00 45.00 No Change Date 14-Nov-2013 31-Mar-2015 31-Jul-2019 Communes with at least 25% execution rate of their joint annual work plan Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 7.00 12.00 30.00 No Change Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Nutritional Care Group members in place for delivering community-based services Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 10693.00 17000.00 New Date 14-Nov-2014 30-Oct-2017 31-Jul-2019 Intermediate Indicators IO_IND_TABLE Communes that disbursed funding for food and nutrition security development Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 10.00 21.00 55.00 No Change Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Multisectoral strategy document for community-based health, food and nutrition standardizing roles and responsibilities of stakeholders Unit of Measure: Yes/No Indicator Type: Custom 4 The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) Baseline Actual (Current) End Target Action Value No No Yes No Change Date 14-Nov-2013 30-Oct-2017 30-Jun-2018 Protocol for community management of moderate acute malnutrition finalized and validated Unit of Measure: Yes/No Indicator Type: Custom Baseline Actual (Current) End Target Action Value No Yes Yes No Change Date 14-Nov-2013 30-Oct-2017 30-Jun-2017 Direct project beneficiaries Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 6857417.00 8500500.00 Marked for Deletion Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Female beneficiaries Unit of Measure: Percentage Indicator Type: Custom Supplement Baseline Actual (Current) End Target Action Value 55.00 67.35 55.00 Marked for Deletion Households in targeted Communes which established a designated hand washing station Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 3369.00 10000.00 Revised Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Children under five with diarrhea who are treated with ORT in targeted Communes Unit of Measure: Percentage Indicator Type: Custom 5 The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) Baseline Actual (Current) End Target Action Value 54.00 33.00 65.00 No Change Date 14-Nov-2013 31-Mar-2015 31-Jul-2019 Women with children under-five and pregnant women attending community nutrition education sessions in targeted Communes Unit of Measure: Percentage Indicator Type: Custom Baseline Actual (Current) End Target Action Value 56.00 75.00 70.00 Revised Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Social and Health Workers (re-)trained on CMAM Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 94.00 565.00 500.00 No Change Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 GAN members trained in community-based nutritional services Unit of Measure: Percentage Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 67.00 80.00 Revised Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Children 6 -59 months who received a vitamin A supplement in the past 6 months Unit of Measure: Percentage Indicator Type: Custom Baseline Actual (Current) End Target Action Value 104.00 95.00 80.00 No Change Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Pregnant/lactating women, adolescent girls and/or children under age five-reached by basic nutrition services (number) Unit of Measure: Number Indicator Type: Custom 6 The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) Baseline Actual (Current) End Target Action Value 0.00 9956454.00 8500500.00 Marked for Deletion Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Children between the age of 6 and 59 months receiving Vitamin A supplementation (number) Unit of Measure: Number Indicator Type: Custom Breakdown Baseline Actual (Current) End Target Action Value 0.00 9680202.00 8000000.00 Marked for Deletion Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Children under the age of 24 months benefiting from improved infant and young child feeding (IYCF) practices (number) Unit of Measure: Number Indicator Type: Custom Breakdown Baseline Actual (Current) End Target Action Value 0.00 44575.00 500000.00 Marked for Deletion Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Children under age five treated for moderate or severe acute malnutrition (number) Unit of Measure: Number Indicator Type: Custom Breakdown Baseline Actual (Current) End Target Action Value 0.00 28445.00 500.00 Marked for Deletion Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 People who have received essential health, nutrition, and population (HNP) services Unit of Measure: Number Indicator Type: Corporate Baseline Actual (Current) End Target Action Value 0.00 9956454.00 8000000.00 No Change Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 Number of women and children who have received basic nutrition services 7 The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) Unit of Measure: Number Indicator Type: Corporate Breakdown Baseline Actual (Current) End Target Action Value 0.00 9956454.00 8000000.00 No Change Date 14-Nov-2013 30-Oct-2017 31-Jul-2019 8 The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) ANNEX 1 : Results Framework and Monitoring/ Cadre de Résultats et Suivi BÉNIN: Projet Multisectoriel de l'Alimentation, de la Santé et de la Nutrition Objectif de Développement du Projet (ODP) : accroître la couverture et l’utilisation des interventions à base communautaire relatives à la nutrition et à la croissance des enfants dans les zones ciblées sur le territoire du bénéficiaire Unité de Valeur Description (Définition des Type de Indicateurs de Résultat de l’ODP* mesure Référence Cible Indicateurs etc.) changement Proportion d’enfants de 0 à 23 Pas de IODP#1 : Enfants de 0 à 23 mois bénéficiant mois ayant fait l’objet de suivi changement d’un paquet minimum d’activités mensuels Pourcentage 0 25 de la croissance dans le mois de promotion de la croissance dans les dernier Communes ciblées IODP#2 : Femmes ayant des enfants de La formation fait référence à un Pas de moins de cinq ans formées et engagées dans cours authentifié. Etre engagé changement Nombre 0 9,000 des activités de production ou de fait référence à une production transformation d’aliments diversifiés et ou transformation à petite riches en nutriments échelle d’aliments IODP#3 : Enfants de 0-6 mois qui sont Proportion des nourrissons de 0 Pas de Pourcentage 33 45 exclusivement allaités au sein maternel dans à 5 mois nourris exclusivement changement les Communes ciblées au lait maternel Les plans de travail conjoint Pas de IODP#4 : Communes ayant atteint un taux sont extraits du cadre commun changement d’exécution d’au moins 25% de leur plan Nombre 7 30 de résultats du CCC et validé par commun annuel de travail le SP CAN IODP#5 : Membres des Groupes Nombre des membres des GAN Nouvel indicateur d’Assistance en Nutrition (GAN) en place dans les villages et organisés Nombre 0 17,000 pour fournir les services à base pour fournir les services de communautaire nutrition. RESULTATS INTERMEDIAIRES Composante 1 : Elaboration, gestion et coordination de politique et des programmes Nombre de Communes ayant Pas de décaissées des fonds dans leur changement IRI#1 : Communes qui décaissent des fonds Nombre 10 55 budget pour la sécurité en faveur du développement de la sécurité alimentaire et nutritionnelle au alimentaire et nutritionnelle cours du dernier exercice fiscal IRI#2 : Document de stratégie Pas de Confirmation de la finalisation multisectorielle pour la santé, l’alimentation changement Y/N N Y et de la validation du document et la nutrition à base communautaires qui de stratégie multisectoriel pour standardise les rôles et responsabilités des la SANC acteurs Confirmation de la finalisation Pas de IRI#3 : Protocole pour la prise en charge Y/N N Y et de la validation du protocole changement communautaire de la malnutrition aigüe de prise en charge de la MAM modérée (MAM) finalisé et validé au niveau communautaire The World Bank Benin Multisectoral Food Health Nutrition Project (P143652) Composante 2 : Mobilisation communautaire et renforcement des prestations de services Nombre, 8,500,500 Marqué pour être IRI#4: Bénéficiaires directes, dont 0 féminines Pas applicable supprimé Pourcentage 50% IRI#5 : Ménages se trouvant dans les 15,000 Nombre de ménages dans les Révision de la Communes ciblées et qui ont aménagé un Nombre 0 zones d’intervention du projet cible du 15,000 à endroit affecté au lavage des mains 10,000 ayant aménagé un endroit 10,000 affecté au lavage des mains N. d’enfants de moins de 5 ans Pas de IRI#6 : Enfants de moins de 5 ans souffrant Pourcentage 54 65 ayant souffert de la diarrhée au changement de la diarrhée et traités à la TRO dans les cours des 2 dernières semaines Communes cibles traité par la TRO Proportion de parents et Révision de IRI#7 : Personnes Femmes avec enfant moins substituts femmes avec enfant l’indicateur : de cinq ans et femmes enceinte participants Pourcentage 56 70 moins de cinq ans qui ont pris « Femmes avec aux séances d’éducation nutritionnelle à part aux séances mensuelles enfant moins de 5 base communautaire dans les Communes d’éducation nutritionnelle au ans » au lieu de ciblées mois dernier « Personnes » IRI#8 : Agents socio-sanitaires formés et Nombre 94 500 Nombre d’agents socio-sanitaire Pas de recyclés en PECMAC formés ou recyclés en PECMAC changement Nombre d’agent de santé Révision de formés Nombre de membres de l’indicateur : GAN formés pour délivrer les « Membres de services de promotion de GAN formés en IRI#9 : Personnel de santé ayant reçu une Nombre 0 1,200 croissance et nutrition dans les nutrition à base formation Membres de GAN formés en villages communautaire » nutrition a base communautaire au lieu de « Personnel de santé ayant reçu une formation » Proportion d’enfants de 6 à 59 Pas de IRI#10 : Enfants de 6 à 59 mois ayant reçu un Pourcentage 104 80 mois ayant reçu un supplément changement supplément en vitamine A au cours des 6 en vitamine A au cours des 6 derniers mois derniers mois N. de femmes enceintes/ Marqué pour être IRI#11 : Femmes enceints/allaitantes, allaitantes, d’adolescentes supprimé adolescentes et/ou enfants de moins de 5 Nombre 0 N/A et/ou d’enfants de moins de 5 ans touchés par les services de nutrition de ans touchés par les services de base nutrition de base