The World Bank Report No: ISR11963 Implementation Status & Results Philippines Philippines Public Health (P115184) Public Disclosure Copy Operation Name: Philippines Public Health (P115184) Project Stage: Implementation Seq.No: 2 Status: ARCHIVED Archive Date: 08-Oct-2013 Country: Philippines Approval FY: 2012 Product Line: Recipient Executed Activities Region: EAST ASIA AND PACIFIC Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 28-Sep-2011 Original Closing Date 31-Dec-2015 Planned Mid Term Review Date 17-Feb-2014 Last Archived ISR Date 22-Jun-2013 Effectiveness Date 09-Jul-2012 Revised Closing Date 31-Dec-2015 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The objective of the Project is to pilot interventions that improve the health status, particularly maternal and reproductive health, of poor populations in the province of Leyte, Southern Leyte, Samar, Northern Samar, and Eastern Samar in the Eastern Visayas Region of the Philippines. It aims to increase the uptake of health services through provision of subsidized health insurance, PhilHealth accreditation of 45 service providers, and subsidized vouchers to cover co-payments for normal spontaneous deliveries.. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Accreditation of 45 health service providers: Provision of training, equipment and supplies to meet 570600.00 PhilHealth accreditation require ments Enrollment with PhilHealth/NHIP 816217.00 Vouchers for co-payment 1281800.00 Public Disclosure Copy Project Management and Implementation 981383.00 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Unsatisfactory Overall Risk Rating Moderate Low Implementation Status Overview The project, which will be implemented between April 2012 and December 2015, is almost 1.5 years into implementation. While currently still on-track to meets its overall Page 1 of 5 The World Bank Report No: ISR11963 development objectives, the preparation for implementation of the voucher scheme (Component 3) is not as advanced as it should be at this stage in the project life-cycle. Progress on training and facility refurbishment (Component 1), by contrast, has been good. Over the next few months, the project will need to undergo some significant changes in design (especially of Component 2) in order to adjust to recent changes in government policy, specifically the decision by the national government to fully subsidize the health insurance premiums of the near-poor. Public Disclosure Copy Progress on key activities is as follows: Component 1 (Accreditation of facilities to meet Philhealth standards for delivery of the maternity care package): 1. Training: 32 midwives (out of 45 providers) have been trained (in two groups) in all of the ten clinical and management competencies necessary for PhilHealth accreditation to deliver the Maternity Care Package (MCP). 2. Upgrading and provision of facilities and supplies: Construction has commenced in 15 of the 17 facilities belonging to the first group of women trained. Once refurbished and equipped, the midwives will be able to apply to Philhealth for accreditation to deliver the Maternity Care Package (MCP). Component 2 (Subsidies for the enrollment of the near-poor, referred to as "Quintile 2"): 1. Subsidized enrollment: The Recipient has enrolled 89,488 families in Philhealth by paying two-year premium subsidies, effectively enabling members to immediately use Philhealth benefits, whether or not the local government unit (LGU) in which the member resides pays its share of the premium. 2. Enrollment empowerment activities: As of June 30, 7,171 barangay health workers have been trained in (in four of the five provinces), covering all LGUs with which Memoranda of Agreement of have been signed for the enrollment of families. These activities, including whether the families enrolled by the project genuinely belong to the category of near-poor still needs to be verified by the independent verification agent. Component 3 (Voucher scheme for maternity care): The design and implementation arrangements for the voucher scheme have not progressed beyond that which was described in the project's operations manual. The design and implementation arrangements will need to be finalized soon in order to allow sufficient time for implementation during the life of the project. The output-based aid payment modality requires pre-financing of activities which are subsequently reimbursed after results have been verified by an independent verification agent (IVA). The independent verification agent (IVA) has established a baseline against which performance can be measured. Over the next few months, progress on the enrollment activities described in Component 2 will be verified by the IVA and eligible activities will be reimbursed by the World Bank. Locations Country First Administrative Division Location Planned Actual Philippines Eastern Visayas Eastern Visayas ✔ ✔ Results Public Disclosure Copy Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of midwives who have been trained, Number Value 0.00 0.00 45.00 have had facilities upgraded (renovation and Date 30-Jun-2012 15-Sep-2013 31-Dec-2015 equipment) and have delivered services for at Comments Training of 32 midwives, in least three months two batches, completed. Renovations of 15 facilities started. Page 2 of 5 The World Bank Report No: ISR11963 Number of Quintile 2 families enrolled in Number Value 0.00 89488.00 145753.00 PhilHealth by the implementing NGO Date 30-Jun-2012 15-Sep-2013 31-Dec-2015 Comments Number is lower than Public Disclosure Copy previous ISR because Philhealth and Recipient cleaned list to remove duplicate names. Not yet verified by IVA.Total expected to contain some non-Q2 families. Number of subsidies paid under the voucher Number Value 0.00 0.00 58000.00 scheme Date 15-Sep-2013 31-Dec-2015 Comments Voucher scheme not yet implemented. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Health facilities constructed, renovated, and/or Number Value 0.00 0.00 45.00 equipped (number) Date 30-Jun-2012 15-Sep-2013 31-Dec-2015 Comments Renovations of 15 facilities started. Births (deliveries) attended by skilled health Number Value 0.00 0.00 58000.00 personnel (number) Date 30-Jun-2012 15-Sep-2013 31-Dec-2015 Comments Target is equal to number of births subsidized by voucher scheme. Health information system cannot be used to capture births in private facilities. Health personnel receiving training (number) Number Value 0.00 35.00 45.00 Public Disclosure Copy Date 30-Jun-2012 15-Sep-2013 31-Dec-2015 Comments Three midwives in addition to those 45 targeted for Component 1 were trained. Direct project beneficiaries Number Value 0.00 492219.00 855545.00 Date 30-Jun-2012 15-Sep-2013 31-Dec-2015 Comments 89,488 families (equal to 145,000 families (equal to 492,184 individuals, ratio of 725,000 individuals, ratio of 5.5) receive Philhealth Page 3 of 5 The World Bank Report No: ISR11963 5.5 per family) subsidies 35 midwives trained 58,000 vouchers 45 midwives Female beneficiaries Percentage Value 0.00 246127.00 420545.00 Public Disclosure Copy Sub Type Supplemental Data on Financial Performance (as of 24-Jul-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P115184 TF-10757 Effective 10-Apr-2012 10-Apr-2012 09-Jul-2012 31-Dec-2015 31-Dec-2015 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P115184 TF-10757 Effective USD 3.65 3.65 0.00 0.30 3.35 8.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation 1. Since, from January 2014, the national government will be shouldering the Philhealth premiums of the near-poor ("Quintile 2") group, Component 2 will be redesigned and funds under this component re-allocated to other components or to new activities within this component. The recipient will submit a proposal for a new use of funds to the World Bank. Page 4 of 5 The World Bank Report No: ISR11963 2. In order to ensure that the design of the voucher scheme has largest impact on maternal health outcomes possible, and also can be feasibly implemented within the existing budget and timeline, the Recipient will submit a revised proposal for the voucher scheme to the Bank. Restructuring History Public Disclosure Copy There has been no restructuring to date. Related Projects There are no related projects. Public Disclosure Copy Page 5 of 5