The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) Health Sector Development Support Project (P125229) AFRICA EAST | Zimbabwe | Health, Nutrition & Population Global Practice | Recipient Executed Activities | Investment Project Financing | FY 2012 | Seq No: 18 | ARCHIVED on 28-Mar-2021 | ISR45945 | Implementing Agencies: Republic of Zimbabwe, Stichting Cordaid Key Dates Key Project Dates Bank Approval Date: 29-Sep-2011 Effectiveness Date: 08-Dec-2011 Planned Mid Term Review Date: 11-Feb-2013 Actual Mid-Term Review Date: 22-Feb-2013 Original Closing Date: 30-Apr-2023 Revised Closing Date: 30-Apr-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to increase coverage of key maternal and child health interventions in targeted ruraldistricts consistent with the Recipient's ongoing health initiatives. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) The Project Development Objective is to increase coverage and quality of an integrated package of Reproductive, Maternal, Neonatal, Child, Adolescent health and nutrition (RMNCAH-N) services, as well as strengthen COVID-19 response and institutional capacity to manage performance-based contracts consistent with the Recipients’ ongoing health initiatives. Components Table Name Results Based Financing in Delivery of Packages of Key Maternal, Child, and Other Related Health Services (RMNCAH-N):(Cost $36.85 M) Management and Capacity Building:(Cost $26.30 M) Monitoring, Documentation, and Verification of Results under Performance-based Contracts:(Cost $4.55 M) COVID-19 Response:(Cost $5.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The total grant financing for the Health Sector Development Support (HSDS) Project is US$78 million, made up of the original US$15 million grant approved in September 2011, a US$20 million Additional Financing (AF) grant approved in July 2013, a second US$10 million AF approved in 3/28/2021 Page 1 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) December 2015, a third US$5 million AF approved in July 2017, a fourth US$3 million AF approved in January 2019, and a fifth US$25 million AF approved in September 2020. The HSDS Project has made significant progress since July 2011. Additional Financing IV which closed on December 31, 2020, performed moderately satisfactorily toward the attainment of its Project Development Objectives. As of December 2020 (latest data available), six out of 11 PDO indicators have been achieved while three were close to being met. Nine out of 15 intermediate results indicators were met while five improved with two close to being achieved. In December 4, 2020, Additional Financing V became effective. In addition to supporting activities that will improve the coverage and quality of reproductive, maternal, neonatal, child and adolescent health and nutrition services, it supports activities that will strengthen Zimbabwe’s response to COVID-19. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- High High Sector Strategies and Policies -- Low Low Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and -- Substantial Substantial Sustainability Fiduciary -- Substantial Substantial Environment and Social -- Substantial Substantial Stakeholders -- Moderate Moderate Other -- Low Low Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes Increase coverage of key RMNCAH-N services in participating districts IN00968851 ►Percentage of women who had their first ANC visit during the first twelve weeks of pregnancy in participating rural districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 24.00 20.00 32.00 Date 31-Dec-2012 31-Dec-2019 31-Jan-2021 30-Apr-2023 3/28/2021 Page 2 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) Higher than baseline but decreased since last year. Comments: IN00968853 ►Percentage of children 6 to 59 months with vitamin A supplementation in participating rural districts. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 40.00 40.00 28.00 50.00 Date 31-Dec-2019 30-Apr-2020 31-Jan-2021 30-Apr-2023 Decrease since last year. Data are being rechecked because it seems that the baseline should have been 30 percent instead of 40 percent. If the baseline is confirmed to be 30 percent, the decrease from last Comments: year would be reduced from 12 percent to two percent. Increase quality of key MCH services in participating districts IN00968852 ►Percentage of participating district, provincial and central hospitals that have registered an increase in quality scores since last quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 25.00 25.00 62.00 50.00 Date 31-Dec-2019 31-Dec-2019 31-Dec-2020 30-Apr-2023 Target exceeded. 62% of hospitals increased their quality score by at least one percent while 31% of Comments: hospitals increased their quality score by more than five percent. Strengthen institutional capacity in RBF Contract Management IN00968759 ►Percentage of health facilities managed under RBF contracts by the MOHCC Program Coordination Unit in participating rural districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 23.00 23.00 80.00 Date 31-Dec-2012 31-Dec-2019 15-Mar-2021 30-Apr-2023 Remained the same since June 2019. Zimbabwe's macroeconomic situation that was worsened by COVID made it difficult for the GOZ to finance RBF subsidies in more districts in 2020 despite the Comments: MOHCC's wish to move forward with RBF institutionalization. Strengthen COVID-19 response IN00968760 ►Percentage of close contacts of confirmed COVID-19 cases followed up based on national guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 80.00 80.00 3/28/2021 Page 3 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) Date 28-Feb-2020 30-Apr-2020 29-Jan-2021 30-Jun-2021 Please note that 80% is only partial information obtained from areas (Mashonaland East Province) with functioning Go-data system. This indicator will need to be updated once the performance based Comments: contracts for surveillance are signed and the monitoring and verification system is in place. Intermediate Results Indicators by Components Component 1: Delivery of Packages of RMNCAH-N and Other Related Health Services IN00968855 ►Cumulative number of health facilities enrolled in RBF program in participating districts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 422.00 424.00 1,155.00 Date 31-Dec-2012 31-Dec-2019 15-Mar-2021 30-Apr-2023 IN00968865 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,479,781.00 4,046,300.00 4,847,512.00 Date 31-Dec-2012 30-Sep-2019 31-Jan-2021 30-Apr-2023 IN00968869 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,845,649.00 2,100,030.00 2,515,859.00 IN00968870 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 709,929.00 817,556.00 929,004.00 Date 31-Dec-2012 30-Sep-2019 31-Jan-2021 30-Apr-2023 IN00968871 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,923,727.00 2,244,678.00 2,768,670.00 Date 31-Dec-2012 30-Sep-2019 31-Jan-2021 30-Apr-2023 IN00968872 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) 3/28/2021 Page 4 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 846,125.00 984,066.00 1,149,839.00 Date 31-Dec-2012 30-Sep-2019 31-Jan-2021 30-Apr-2023 IN00968873 ►Cumulative number of children under 5 who had their Mid Upper Arm Circumference and Height measured by Community Health Workers (CHWs) as part of growth monitoring. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 121,500.00 Date 27-Apr-2020 27-Apr-2020 15-Mar-2021 30-Apr-2023 Community-based RBF still to be initiated for this indicator to be measured. Comments: IN00968874 ►Percentage of 15-49-year-old women who are new acceptors of long term, reversible family planning methods in participating districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 21.40 21.40 18.00 30.00 Date 31-Dec-2019 31-Dec-2019 31-Jan-2021 30-Apr-2023 Decrease since 2020 due to drop in service utilization because of COVID pandemic and macroeconomic Comments: situation. Component 2. Management and Capacity Building in RBF IN00968854 ►Number of health personnel and community health workers (CHWs) receiving training on RBF in participating districts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,072.00 4,222.00 5,792.00 Date 31-Dec-2012 30-Sep-2019 15-Mar-2021 30-Apr-2023 Target surpassed. This indicator measures the cumulative number of health personnel receiving RBF and associated training Comments: linked to core services of the project. IN00968856 ►Percentage of health facilities implementing Continuous Quality Improvement model in the participating rural districts. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11.00 17.00 70.00 Date 01-Sep-2015 30-Sep-2019 15-Mar-2021 30-Apr-2023 New training for the additional facilities will be given from Q2 to Q4 2021 Comments: IN00968860 ►Number of health workers that received first time training or refresher training on Emergency Obstetrics and Neonatal Care using skill labs (Number, Custom) 3/28/2021 Page 5 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 280.00 Date 27-Apr-2020 27-Apr-2020 15-Mar-2021 30-Apr-2023 Training is being planned. Comments: IN00968863 ►Percentage of MOHCC cost centers utilizing resource allocation formula in line with the whole Government Management Performance System (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 01-Jan-2020 30-Apr-2020 15-Mar-2021 30-Apr-2023 Not yet applicable. Process to develop resource allocation formula will start in Q2 2021 and the tool would Comments: be available for use in the development of 2022 budget. IN00968868 ►Percentage of resources allocated to primary health care (PHC) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 5.00 5.00 8.00 Date 31-Jan-2020 31-Jan-2020 15-Mar-2021 30-Apr-2023 This will be updated after obtaining the Government budget blue book for 2021 Comments: Component 3.Monitoring, Documentation, Verification of Results under Performance-based Financing IN00968858 ►Number of District Health Executives (DHEs) in participating districts using updated quality checklist with the COVID-19 component for supervision of health facilities. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 20.00 Date 27-Apr-2020 27-Apr-2020 15-Mar-2021 30-Apr-2023 The COVID-19 addendum was developed and piloted in two districts and it is being finalized to be rolled Comments: out to other districts in Q2 2021. IN00968861 ►Process evaluation to examine the institutionalization of RBF in the government system as a viable approach to sustainability of RBF (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 27-Apr-2020 27-Apr-2020 15-Mar-2021 30-Apr-2023 Process for evaluation will start later in 2021. Comments: IN00968864 3/28/2021 Page 6 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) ►Process evaluation to examine the effectiveness of quality focused RBF at provincial hospitals in improving the quality of maternal and neonatal care for improved outcomes. (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 27-Apr-2020 27-Apr-2020 15-Mar-2021 29-Jul-2022 Process for evaluation will start in 2022 after the new initiative has been implemented for at least a year. Comments: IN00968867 ►Percentage of grievances addressed within 4 weeks of initial complaint being recorded (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 65.00 Date 31-Jan-2020 30-Apr-2020 15-Mar-2021 30-Apr-2023 Project is working on having a standardized SOP that will be used by all facilities on GRM reporting. A capacity building workshop with focal points at all levels will be held to standardize GRM Comments: implementation. Project will start reporting on this indicator from Q3 2021 onwards COVID-19 Response IN00968857 ►Percentage of health facilities with minimum package of PPE (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 10.00 64.40 70.00 Date 31-Jan-2020 27-Apr-2020 31-Dec-2020 31-Dec-2020 Since the COVID-19 addendum is not yet rolled out, the project is unable to update this information yet using its own system. Nonetheless, the Vital Medicines Availability and Health Services Survey used by the COVID Response Comments: logistics pillar indicates that the average availability for a package of PPE (caps, masks, gloves, gowns, goggles) is 64.4% in Q4 2020 IN00968859 ►Percentage of affected people including health workers reached with clinical and psycho-social support (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 10.00 10.00 80.00 Date 28-Feb-2020 27-Apr-2020 27-Apr-2020 31-Dec-2020 To be updated once project related support has started. Comments: IN00968862 ►Number of isolation centers complying with infection prevention control (IPC) guidelines (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 3/28/2021 Page 7 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) Value 0.00 0.00 0.00 5.00 Date 31-Jan-2020 27-Apr-2020 15-Mar-2021 31-Dec-2020 To be updated in collaboration with infection prevention control pillar team once project related support Comments: activities have started. IN00968866 ►Number of COVID treatment centers with oxygen therapy (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 at least 5 Date 31-Jan-2020 30-Apr-2020 15-Mar-2021 31-Dec-2020 Project currently reviewing oxygen therapy offers from World Bank Facilitated Procurement. To be Comments: updated after project has procured oxygen therapy equipment. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P125229 TF-10748 Closed USD 15.00 15.00 0.00 15.00 0.00 100% P125229 TF-15111 Closed USD 20.00 20.00 0.00 20.00 0.00 100% P125229 TF-A1598 Closed USD 10.00 10.00 0.00 10.00 0.00 100% P125229 TF-A5311 Closed USD 5.00 5.00 0.00 5.00 0.00 100% P125229 TF-A9037 Closed USD 3.00 3.00 0.00 3.00 0.00 100% P125229 TF-B3156 Effective USD 25.00 25.00 0.00 3.67 21.33 15% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P125229 TF-10748 Closed 27-Sep-2011 27-Sep-2011 08-Dec-2011 31-Jul-2014 31-Jul-2014 P125229 TF-15111 Closed 30-Jul-2013 30-Jul-2013 25-Sep-2013 30-Oct-2015 28-Feb-2017 P125229 TF-A1598 Closed 23-Dec-2015 12-Jan-2016 14-Mar-2016 28-Feb-2017 30-Jan-2018 P125229 TF-A5311 Closed 21-Jul-2017 26-Jul-2017 24-Oct-2017 30-Jun-2018 31-Dec-2019 P125229 TF-A9037 Closed 03-Nov-2018 20-Feb-2019 29-Mar-2019 31-Dec-2019 31-Dec-2020 3/28/2021 Page 8 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) P125229 TF-B3156 Effective 20-Sep-2020 01-Oct-2020 04-Dec-2020 30-Apr-2023 30-Apr-2023 Cumulative Disbursements PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History Level 2 Approved on 01-Sep-2015 ,Level 2 Approved on 21-Feb-2017 ,Level 2 Approved on 27-Jun-2018 ,Level 2 Approved on 20-Dec-2018 ,Level 2 Approved on 06-Dec-2019 ,Level 2 Approved on 25-Jun-2020 Related Project(s) P144532-Additional Financing Health Sector Development Support Project ,P156879-Zimbabwe Health Sector Development Support Project AF II ,P163976-Zimbabwe Health Sector Development Support Project III - AF ,P168734-Zimbabwe Health Sector Development Support Project IV - AF ,P173132-Health Sector Development Support Project - Additional Financing V ,P175232-Health Sector Development Support 3/28/2021 Page 9 of 9