Public Disclosure Copy The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Nepal Health Sector Management Reform Program (P160207) SOUTH ASIA | Nepal | Health, Nutrition & Population Global Practice | IBRD/IDA | Program-for-Results | FY 2017 | Seq No: 2 | ARCHIVED on 11-Oct-2017 | ISR29667 | Implementing Agencies: Ministry of Health, Ministry of Finance Program Development Objectives Program Development Objective (from Program-for-Results Appraisal Document) The Program Development Objective is to improve efficiency in public resource management systems of the health sector in Nepal. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Satisfactory Overall Implementation Progress (IP)  Satisfactory  Satisfactory Overall Risk Rating  High  High Implementation Status and Key Decisions The Nepal Health Sector Management Reform Program for Results was approved by the Board of Directors on January 13, 2017. An IDA Credit in the amount of US$150 million was signed by Nepal and the World Bank on March 2, 2017. The Program became effective on April 13, 2017. The second implementation support review took place on September 11-15, 2017. Based on the information available, the progress towards achieving the program development objective and the progress of implementation are satisfactory. It is expected that eight out of the nine the first-year Disbursement Linked Results (DLRs) will be achieved. Additionally, two of second- year DLRs will be achieved. The value of these results from the IDA Credit is about US$23 million equivalent. The reporting and verification process is well advanced with the first disbursement expected to take place before end-November 2017. Though not yet due, progress has been made necessary to achieve the program indicators of reducing stock-outs through an improved logistics management system, capturing MOH expenditures in the financial management system and improving information through the planned rollout of the District Health Information Software 2 (DHIS 2). Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P160207 IDA-59130 Effective USD 150.00 150.00 0.00 0.00 145.90 0% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date 10/11/2017 Public Disclosure Copy Page 1 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) P160207 IDA-59130 Effective 13-Jan-2017 02-Mar-2017 13-Apr-2017 15-Jul-2021 -- Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  High  High  High Macroeconomic  Moderate  Moderate  Moderate Sector Strategies and Policies  Moderate  Moderate  Moderate Technical Design of Project or Program  Moderate  Moderate  Moderate Institutional Capacity for Implementation and Sustainability  High  High  High Fiduciary  High  High  High Environment and Social  Low  Low  Low Stakeholders  Moderate  Moderate  Moderate Other  Moderate  Moderate  Moderate Overall  High  High  High Disbursement Linked Indicators (DLI) PHDLIPDOTBL  Percentage of contracts managed by the LMD through PPMO's online e-procurement portal (DLI 1). (Percentage) Baseline Actual (Previous) Actual (Current) Value 0.00 -- -- Date 13-Jan-2017 -- -- Comments Year 1 target: (i) Training on the use of PPMO's online e-procurement completed for at least 20 MoH staff; (ii) standard bidding documents for drugs and equipment developed for online e-procurement. Status as of September 15, 2017: (i) achieved; (ii) Not achieved. Standard bidding documents have been prepared but need to be finalized in collaboration with PPMO. MOH, with Bank’s support, to follow-up with the Secretary of the PPMO upon his return from travels. PHDLIPDOTBL  Production and submission of the annual report on grievances received and addressed through a web-based grievance redressal mechanism (DLI 2). (Text) Baseline Actual (Previous) Actual (Current) Web-based Grievance Guidelines for Grievance Redressal Mechanism for Value -- Redressal mechanism endorsed procurement is not by MOH established. 10/11/2017 Public Disclosure Copy Page 2 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Date 13-Jan-2017 -- 15-Sep-2017 Comments Year 1 target: Guidelines for Grievance Redressal mechanism endorsed by MOH Status as of September 15, 2017: Achieved PHDLIPDOTBL  Percentage of procurements done by the LMD using standard specifications (DLI 3). (Text) Baseline Actual (Previous) Actual (Current) MoH reported it has endorsed Not based on standard standard specifications for basic Value -- specifications. package of drugs to be procured by LMD. Date 13-Jan-2017 -- 13-Apr-2017 Comments Year 1 target: MoH endorses standard specifications for basic package of drugs to be procured by LMD. Status as of September 15, 2017: Likely achieved. The MOH need to ensure that specifications online reflect the latest approved essential medicine list and to provide NHRC with the latest list. PHDLIPDOTBL  Percentage of district stores reporting based on the LMIS (DLI 4). (Text) Baseline Actual (Previous) Actual (Current) Percentage of district stores Value -- N/A reporting based on the LMIS. Date 13-Jan-2017 -- 13-Apr-2017 Comments Target / result begins in Year 2. PHDLIPDOTBL  Percentage reduction of stock-outs of tracer drugs in district stores (DLI 5). (Text) Baseline Actual (Previous) Actual (Current) Percentage as evidenced by Value -- N/A LMIS data in year 3. Date 13-Jan-2017 -- 13-Apr-2017 Comments No target for Year 1. 10/11/2017 Public Disclosure Copy Page 3 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) PHDLIPDOTBL  Percentage improvement in the EVM score over 2014 baseline (DLI 6). (Text) Baseline Actual (Previous) Actual (Current) Average EVM score of 64%, Value with two attributes achieving -- N/A 80%. Date 13-Jan-2017 -- 13-Apr-2017 Comments Results to be achieved in Year 2 and Year 4. PHDLIPDOTBL  Percentage of the MoH spending entities submitting annual plan and budget using eAWPB (DLI 7). (Text) Baseline Actual (Previous) Actual (Current) Not all spending units MoH reports that the targets for Value submitting annual plan and -- Years 1 & 2 have been met. budget using eAWPB. Date 13-Jan-2017 -- 15-Sep-2017 Comments Year 1 target: MoH and all its departments, divisions and centers are given access to operate on eAWPB. Year 2 target: eAWPB used for planning and budget submission by MOH and all departments, divisions and centers Status as of September 15, 2017: Year 1-Achieved; and Year 2-Achieved.The access and entry of the eAWPB of the DOHS to be verified. PHDLIPDOTBL  Percentage of the MoH's annual spending captured by the TABUCS (DLI 8). (Percentage) Baseline Actual (Previous) Actual (Current) Value 70.00 -- -- Date 13-Jan-2017 -- 13-Apr-2017 Comments Year 1 target: MoH has issued a circular mandating expenditure reporting through TABUCS by all spending units. Status as of September 15, 2017: Achieved PHDLIPDOTBL  Percentage of audited spending units responding to the OAG's primary audit queries within thirty-five (35) days (DLI 9). (Text) Baseline Actual (Previous) Actual (Current) Percentage as derived from Value MoH inventory of responses -- Year 1 target- Achieved in the first year. 10/11/2017 Public Disclosure Copy Page 4 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Date 13-Jan-2017 -- 15-Sep-2017 Comments Year 1 target: All reports containing primary audit queries received by auditing spending units available at the MoH and inventory of responses by date provided by individual audited spending units available at the MoH. Status as of September 15, 2017: Achieved. The detailed analysis of the inventory to establish the baseline is still to be finalized. PHDLIPDOTBL  Percentage of districts which have all facilities reporting annual disaggregated data using DHIS 2 (DLI 10). (Percentage) Baseline Actual (Previous) Actual (Current) Value 0.00 -- -- Date 13-Jan-2017 -- -- Comments Year 1 target: Plan for roll out of DHIS 2 finalized and DHIS 2 rolled out up to DHO level. Year 2 target; Reports based on DHIS 2 available from all DHOs Status as of September 15, 2017: Year 1- achieved and Year 2-achieved. MOH informed the mission that the Year 2 DLR is also met and will be reported as part of this verification cycle. PHDLIPDOTBL  Operationalization of the citizen feedback mechanisms and systems for public reporting (DLI 11). (Text) Baseline Actual (Previous) Actual (Current) No citizen feedback Value -- Year 1 DLR -achieved mechanism in place. Date 13-Jan-2017 -- 15-Sep-2017 Comments Year 1 target: Citizen engagement mechanism options and public reporting systems developed by MoH for feedback on availability of drugs and facility-level services and disaggregated by gender. Status as of September 15, 2017: Achieved. Results Results Area Intermediate Results Area 1. Improved Public Procurement 2. Improved Financial Management 3. Improved Reporting and Information Sharing for Enhanced Accountability and Transparency 10/11/2017 Public Disclosure Copy Page 5 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Project Development Objective Indicators PHINDPDOTBL  Percentage reduction of stock-outs of tracer drugs (DLI 5) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 25% reduction in stock-outs of tracer drugs in at least two Percentage as evidenced N/A - target set for N/A - target set for Year Value regions over by LMIS data in year 3 Year 2 4 the baseline established in year 3 through the LMIS. Date 15-Jul-2019 13-Apr-2017 15-Sep-2017 15-Jul-2021 Comments Not yet due. PHINDPDOTBL  Percentage of the MoH's annual spending captured by TABUCS (DLI 8) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 70.00 -- -- 95.00 Date 13-Jan-2017 -- -- 15-Jul-2021 Comments Target set for Year 2, so not yet due. PHINDPDOTBL  Percentage of districts which have all facilities reporting annual disaggregated data using DHIS 2 (DLI 10) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- 75.00 Date 13-Jan-2017 -- -- 15-Jul-2021 Comments Target set for Year 2, so not yet due. 10/11/2017 Public Disclosure Copy Page 6 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Overall Comments Intermediate Results Indicators PHINDIRITBL  Percentage of contracts managed by the LMD through PPMO's online e-procurement portal (DLI 1) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- 90.00 Date 13-Jan-2017 -- -- 15-Jul-2021 Comments DLR 1.1 Training on the use of PPMO’s online e-procurement completed for at least 20 MoH staff- Achieved DLR1.2 Standard bidding documents for drugs and equipment developed for online e-procurement- Not achieved. Standard bidding documents have been prepared but need to be finalized in collaboration with PPMO. MOH, with Bank’s support, to follow-up with the Secretary of the PPMO upon his return from travels. PHINDIRITBL  Production and submission of annual report on grievances received and addressed through a web-based Grievance Redressal Mechanism (DLI 2) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target MoH requested technical assistance Web-based Grievance Annual report from Development Redressal Mechanism for on grievances Value Partners to help them Year 1 target: Achieved procurement is not received and draft guidelines established. addressed. customized for their needs. Date 13-Jan-2017 13-Apr-2017 15-Sep-2017 15-Jul-2021 Comments DLR 2.1 Guidelines for Grievance Redressal mechanism endorsed by MOH- Achieved 10/11/2017 Public Disclosure Copy Page 7 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) PHINDIRITBL  Percentage of procurements done by the LMD using standard specifications (DLI 3) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 90% of procurement of MoH reported that they basic package have endorsed of drugs and Not based on standard standard specifications Value Year 1 target achieved essential specifications for basic package of equipment drugs to be procured based on the by LMD. use of standard specifications Date 13-Jan-2017 13-Apr-2017 15-Sep-2017 15-Jul-2021 Comments DLR 3.1 MOH endorses standard specifications for basic package of drugs to be procured by LMD- Achieved PHINDIRITBL  Percentage of district stores reporting based on the LMIS (DLI 4) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target LMIS reports received from all central warehouses Value 0.00 N/A N/A and all district stores of at least two regions. Date 13-Jan-2017 13-Apr-2017 15-Sep-2017 15-Jul-2021 PHINDIRITBL  Installation of the LMIS to produce real-time web-based information (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Installation of LMIS to produce real- Real-time web-based LMIS Value N/A N/A time web-based not in place information in all central warehouses 10/11/2017 Public Disclosure Copy Page 8 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Date 13-Jan-2017 13-Apr-2017 15-Sep-2017 15-Jul-2021 PHINDIRITBL  Training on LMIS completed in central warehouses and district stores (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Training on operation of LMIS and installation completed for all central Value - N/A N/A warehouses and district stores and baseline data generated for stock-outs of tracer drugs Date 13-Jan-2017 -- 15-Sep-2017 15-Jul-2021 PHINDIRITBL  Percentage improvement in EVM score over 2014 baseline (DLI 6) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Average EVM score of 80% Average EVM score of (based on 2018 N/A. Target set for N/A. Target set for Year Value 64%, with two attributes Survey) with Year 2. 2. achieving 80% any six attributes achieving 80% Date 13-Jan-2017 13-Apr-2017 15-Sep-2017 15-Jul-2020 PHINDIRITBL  Percentage of all MoH spending entities submitting annual plan and budget using eAWPB (DLI 7) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target eAWPB used for plan and budget submission by Not all spending units MoH reports targets for MoH and all Year 1 and Year 2 Value submitting annual plan and Year 1 and Year 2 departments, targets achieved. budget using eAWPB have been met. divisions, and centers, and 100% decentralized spending units. 10/11/2017 Public Disclosure Copy Page 9 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Date 13-Jan-2017 13-Apr-2017 13-Apr-2017 15-Jul-2021 Comments DLR 7.1 MOH and all its departments, divisions and centers are given access to operate on eAWPB- Achieved DLR 7.2 eAWPB used for planning and budget submission by MOH and all departments, divisions and centers- Achieved. The access and entry of the eAWPB of the DOHS to be verified. PHINDIRITBL  Percentage of audited spending units responding to the OAG’s primary audit queries within 35 days (DLI 9) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 10 percentage points increase in the number of audited institutions responding to primary audit Percentage as derived queries within Value from MoH inventory of -- -- 35 days over responses in the first year percentage derived from the MoH inventory of responses of the previous year Date 17-Jul-2017 -- -- 15-Jul-2021 Comments DLR 9.1 All reports containing primary audit queries received by auditing spending units available at the MOH and inventory of responses by date provided by individual audited spending units available at the MOH Status- Achieved. The detailed analysis of the inventory to establish the baseline is still to be finalized. PHINDIRITBL  DHIS 2 implementation roadmap finalized (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target MoH reported that the plan for roll out of DHIS Plan for roll out Year 1 and Year 2 Value No DHIS 2 2 is finalized and DHIS of DHIS 2 targets achieved. 2 has been rolled out finalized up to district level. Date 13-Jan-2017 13-Apr-2017 15-Sep-2017 15-Jul-2021 10/11/2017 Public Disclosure Copy Page 10 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Comments DLR 10.1 Plan for roll out of DHIS 2 finalized and DHIS 2 rolled out up to DHO level- Achieved. DLR 10.2 Reports based on DHIS 2 available from all DHOs- Achieved. MOH informed the mission that the year 2 DLR is also met and will be reported as part of this verification cycle PHINDIRITBL  Operationalization of the citizen feedback mechanisms and systems for public reporting (DLI 11) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Citizen feedback reports, based on data from six pilots in targeted geographical areas, on No citizen feedback MoH requested availability of Value Year 1 target achieved mechanism in place technical assistance. drugs and facility- level services and disaggregated by gender available in public domain including on MoH website. Date 13-Jan-2017 13-Apr-2017 13-Apr-2017 15-Jul-2021 Overall Comments DLR 11.1 Citizen engagement mechanism options and public reporting systems developed by MOH for feedback on availability of drugs and facility-level services and disaggregated by gender Status- Achieved 10/11/2017 Public Disclosure Copy Page 11 of 11