Public Disclosure Copy The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Ethiopia Health MDG Support Operation (P123531) AFRICA | Ethiopia | Health, Nutrition & Population Global Practice | IBRD/IDA | Program-for-Results | FY 2013 | Seq No: 11 | ARCHIVED on 08-Dec-2017 | ISR29596 | Implementing Agencies: Federal Ministry of Finance and Economic Cooperation, Federal MOH Ethiopia Program Development Objectives Program Development Objective (from Program-for-Results Appraisal Document) To improve the delivery and use of a comprehensive package of maternal and child health services. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Satisfactory Overall Risk Rating  High  High Implementation Status and Key Decisions The Ethiopia Health MDGs P4R is the first Bank operation using the P4R instrument in the Health, Nutrition, and Population Global Practice of the World Bank in Ethiopia. The PDO of the Health MDGs P4R is to improve the delivery and use of a comprehensive package of maternal and child health (MCH) services. The P4R focuses on Maternal Child Health (MCH) services and specific areas of health system strengthening including procurement, financial management, safeguards, monitoring and evaluation, etc. Upon achievement of the identified Disbursement-Linked Indicators (DLIs), disbursement is made into the MDG Performance Fund (MDG PF now SDG PF), a pooled fund supported by 11 development partners and managed by the Federal Ministry of Health (FMOH). The original Program is financed through an IDA Credit in the amount of SDR65.1 million (US$100 equivalent) that was approved on February 28, 2013 and became effective on June 17, 2013 with an original closing date of June 30, 2018, and a Health Results Innovation Trust Fund (HRITF) Grant in the amount of US$20 million for the Ethiopia MDG Support P4R that was approved on March 29, 2013 and became effective on March 29, 2013 with original closing date of June 30, 2018. The program is accompanied by an additional Grant in the amount of US$400,000 that was approved on December 23, 2013 and became effective on December 23, 2013, with an original closing date of June 30, 2015 that was extended to February 28, 2018. To date, US$59.8 has been disbursed from IDA (equal to 60% of total IDA funds); US$13.80 million has been disbursed from the HRITF (equal to 69% of the HRITF); and US$208, 205.00 of the additional Grant has been disbursed. These disbursements include advance payments as well as disbursements for achievement of various DLIs. The Additional Financing was approved and signed in the amount of US$230.00 million to the program. The AF comprises of an additional IDA credit equivalent of US$150 million, a grant of US$60 million from the Global Financing Facility for Every Woman Every Child and a grant of US$20 million from the Power of Nutrition. The AF was approved by the Bank’s Board on May 9, 2017 and was signed on May 18, 2017. The AF was discussed in parliament on June 14, 2017 and received the endorsement of the parliament as part of the ratification process. The AF brings on board additional DLIs to address equity, quality challenges and also support the government's program on nutrition, health care financing and Civil Registration and Vital Statistics (CRVS). The AF also supports select capacity building needs. Data on Financial Performance 12/8/2017 Public Disclosure Copy Page 1 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P123531 IDA-52090 Effective USD 100.00 100.00 0.00 68.06 26.16 68% P123531 IDA-60900 Effective USD 150.00 150.00 0.00 0.00 156.63 0% P123531 TF-14107 Effective USD 20.00 20.00 0.00 13.80 6.20 69% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P123531 IDA-52090 Effective 28-Feb-2013 29-Mar-2013 17-Jun-2013 30-Jun-2018 -- P123531 IDA-60900 Effective 09-May-2017 18-May-2017 27-Jun-2017 30-Jun-2021 -- P123531 TF-14107 Effective 29-Mar-2013 29-Mar-2013 29-Mar-2013 30-Jun-2018 -- Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  High  High Macroeconomic  --  Substantial  Substantial Sector Strategies and Policies  --  Moderate  Moderate Technical Design of Project or Program  --  Moderate  Moderate Institutional Capacity for Implementation and Sustainability  --  Moderate  Moderate Fiduciary  --  Substantial  Substantial Environment and Social  --  High  High Stakeholders  --  High  High Other  --  --  -- Overall  --  High  High Disbursement Linked Indicators (DLI) PHDLIPDOTBL  Deliveries attended by skilled birth providers (Percentage) Baseline Actual (Previous) Actual (Current) Value 10.00 16.00 26.00 12/8/2017 Public Disclosure Copy Page 2 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Date 31-Mar-2012 30-Apr-2014 22-Jun-2017 Comments According to DHS 2016, DLI 1 result was fully achieved for which SDR 3,225,000.00 was disbursed for the 2016 target and disbursement will also be made for the over achievement by 8 percentage points. Under the AF this DLI is scaled for further results from baseline 26% to 40%. Additional new DLI 1b, deliveries attended by skilled birth provider for the bottom three performing regions (Afar, Oromia and Somali), is added to address differences in using Skilled Birth Delivery Services. PHDLIPDOTBL  Children 12-23 months immunized with Pentavalent 3 vaccine (Percentage) Baseline Actual (Previous) Actual (Current) Value 65.70 65.70 65.70 Date 31-Dec-2012 31-Dec-2012 31-Dec-2012 Comments Updated information is expected from the upcoming cluster survey by the end of 2018. PHDLIPDOTBL  Pregnant women receiving at least one antenatal care visit (Percentage) Baseline Actual (Previous) Actual (Current) Value 43.00 58.50 62.40 Date 31-Mar-2013 30-Apr-2014 22-Jun-2017 Comments The original target was fully achieved and according to the EDHS 2016 report, ANC from skilled provider is 62.4% and ANC+4 is 31.8%. Based on the Health Sector Transformation Plan focus, under AF the DLI ANC (at least one visit) was dropped and a new DLI 3a- ANC+4 has been added. PHDLIPDOTBL  Contraceptive prevalence rate (Percentage) Baseline Actual (Previous) Actual (Current) Value 27.30 40.40 35.00 Date 31-Mar-2012 30-Apr-2014 22-Jun-2017 Comments The difference between the methodology used in mini EDHS 2014 and EDHS 2016 could be the main factor, though the overall trend from baseline is positive. The target for this DLI which was the national level was achieved at 35%. Accordingly, under the AF a New DLI 4a, Contraceptive Prevalence rate for rural women only, is added in the AF to spur results in rural areas. 12/8/2017 Public Disclosure Copy Page 3 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) PHDLIPDOTBL  Health centers reporting HMIS data in time (Percentage) Baseline Actual (Previous) Actual (Current) Value 50.00 68.00 68.00 Date 31-Mar-2012 30-Jun-2014 30-Jun-2014 Comments The team learnt during the preparation of the AF that the DQA exercise that was expected to be included in SARA 2016 was not well designed and MOH planned to conduct a separate Data Quality Assurance by the end of 2018. PHDLIPDOTBL  Development and implementation of Balanced Score Card Approach to assess performance and related institutional incentives (Yes/No) Baseline Actual (Previous) Actual (Current) Value N N N Date 31-Mar-2013 01-Oct-2014 01-Oct-2014 Comments DLI dropped: No disbursement against results for this DLI and the disbursements made to date have been advances (6a: SDR 325k, US$250k; 6b: SDR 1.95m, US$500k). Progress was delayed due to the Government decision to change the roll out modality for the BSC; the Bank and Government have agreed to drop the DLI as part of restructuring and AF and replace it with a new DLI on service quality. Accordingly, DLI 13, Percent of Primary Health Care facilities having all drugs from the MOH list of essential drugs, has been added to improve the quality of health care services. PHDLIPDOTBL  Development and implementation of Annual Rapid Facility Assessment (Yes/No) Baseline Actual (Previous) Actual (Current) Value N Y Y Date -- 15-Dec-2015 15-Dec-2015 Comments The 2013 target was met and total disbursements made under DLI 7a consist of SDR 1.3m and USD 2m and for DLI 7b, a total of SDR 1.6m was also disbursed. The SPA+ 2014 was finalized and served as the basis for the result of this DLI. As a result, SDR 1.2 m was disbursed for SPA+ and action plan. SARA 2016 has also been finalized and action plan to address the weaknesses was developed and submitted to the Bank. A total of SDR1,449,275.00 was disbursed. PHDLIPDOTBL  Transparency of PFSA procurement process (Yes/No) Baseline Actual (Previous) Actual (Current) Value N N N 12/8/2017 Public Disclosure Copy Page 4 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Date 31-Mar-2013 30-Nov-2014 30-Nov-2014 Comments The 2014 target of a having a website in place which discloses agreed procurement information has been achieved. The Bank has cleared disbursements of US$2m. To date, disbursements have been SDR 325k under DLI 8a and SDR 813.8k under DLI 8b. Second year (FY 2015) disbursements are still expected under the DLI after the following actions are met: (i) maintaining the website and disclosing the agreed procurement information continuously, and (ii) issuing the first call for prequalification bidders. An independent consultant has been hired to independently verify actions taken in support of the DLI and the team is expecting a report to be submitted by end of FY2018. An additional TA has been hired to work with PFSA on upgrading of the website. Results Results Area Intermediate Results Area Project Development Objective Indicators PHINDPDOTBL  Deliveries attended by skilled birth providers (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 26.00 26.00 18.00 Date 31-Mar-2016 22-Jun-2017 22-Jun-2017 30-Jun-2018 PHINDPDOTBL  Children 12-23 months immunized with Pentavalent 3 vaccines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.70 65.70 65.70 76.70 Date 31-Dec-2012 31-Dec-2012 31-Dec-2012 30-Jun-2018 PHINDPDOTBL  Pregnant women receiving at least one antenatal care visit (Percentage, Custom) 12/8/2017 Public Disclosure Copy Page 5 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Baseline Actual (Previous) Actual (Current) End Target Value 43.00 62.40 62.40 56.00 Date 29-Mar-2013 22-Jun-2017 22-Jun-2017 30-Jun-2018 PHINDPDOTBL  Contraceptive prevalence rate (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 27.30 35.00 35.00 35.00 Date 30-Mar-2012 22-Jun-2017 22-Jun-2017 30-Jun-2018 Overall Comments Intermediate Results Indicators PHINDIRITBL  Health Centers reporting HMIS data in time (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 68.00 68.00 80.00 Date 30-Mar-2012 30-Jun-2014 30-Jun-2014 30-Jun-2018 PHINDIRITBL  Development and implementation of Annual Rapid Facility Assessment (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 30-Mar-2012 30-Jun-2016 30-Jun-2016 30-Jun-2018 PHINDIRITBL  Improved transparency of Pharmaceutical Fund and Supply Agency (PFSA) procurement process (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/8/2017 Public Disclosure Copy Page 6 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Value N Y Y Y Date 29-Mar-2013 30-Jun-2016 30-Jun-2016 30-Jun-2018 Overall Comments 12/8/2017 Public Disclosure Copy Page 7 of 7