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 | Requesting Unit: SACNP | Responsible Unit: GHN19 IBRD/IDA | Program-for-Results Financing | FY 2017 | Team Leader(s): Kari L. Hurt, Manav Bhattarai, Vikram Menon Seq No: 4 | ARCHIVED on 07-Nov-2018 | ISR34305 | Created by: Kari L. Hurt on 05-Oct-2018 | Modified by: Kari L. Hurt on 01-Nov-2018 Program Development Objectives Program Development Objective (from Program 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) Moderately Satisfactory Moderately Satisfactory Implementation Status and Key Decisions Based on the information available, the progress towards achieving the program development objective is satisfactory. The Bank team notes the continued commitment of the MOHP and Development Partners to secure the Program results and the continued relevance of the Program during this national transition to a federal structure. The relevance will be continually reassessed as the functions and the financing of the health sector are being decentralized to subnational governments and as the Federal government is restructured to fit its evolving mandate. After accounting for the first-year results (for which two results were achieved ahead of time and one planned result was not achieved), there were now 10 results to be achieved by the end of the Fiscal Year 2017/18. Of these 10 results, seven have been achieved and are being verified. One another result related to social audits is reported to have been achieved and is expected to be verified soon. Though not yet due, progress has been made to achieve the program indicators of reducing stock-outs through an improved logistics management system. 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 25.99 130.11 17% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P160207 IDA-59130 Effective 13-Jan-2017 02-Mar-2017 13-Apr-2017 15-Jul-2021 15-Jul-2021 Program Action Plan 11/19/2018 Page 1 of 11 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Action Description Establish (by January 2017) and maintain a Health Sector Partner Forum at the MoH (with annual consultations). Responsibility Recurrent Frequency Due Date DLI# Status Client Yes YEARLY In Progress Comments Action Description Revise draft regulations for infection control and health care waste management and submit to parliament/cabinet Responsibility Recurrent Frequency Due Date DLI# Status Client No 13-Jul-2018 Not Yet Due Delayed. Draft document is still with Ministry of Forest and Environment (MoFE) and is in the process of being Comments revised. MoHP is yet to develop Integrated infection control and health care waste management strategy. Action Description Expand GESI strategy (to include issues of disability, geriatrics and rehabilitation of gender-based violence victims). Responsibility Recurrent Frequency Due Date DLI# Status Client No 13-Jul-2018 In Progress Comments The GESI Strategy has been finalized and the Nepali version is awaiting endorsement by the cabinet. Strengthen the LMD capacity for planning and budgeting, procurement, supply chain, monitoring, and quality Action Description assurance. Responsibility Recurrent Frequency Due Date DLI# Status Client No 28-Dec-2018 Not Yet Due Comments Not yet due, but suspended due to federal transition. Action Description Finalize CAPP by August every year. Responsibility Recurrent Frequency Due Date DLI# Status Client Yes YEARLY In Progress Comments Action Description Establish a post-shipment quality assurance system. Responsibility Recurrent Frequency Due Date DLI# Status Client No 13-Jul-2018 Delayed 11/19/2018 Page 2 of 11 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Comments Delayed. But process initiated. Improve accountability and reporting mechanisms of grants provided by the MoH to different entities (e.g. grants Action Description provided to autonomous bodies captured by TABUCS). Responsibility Recurrent Frequency Due Date DLI# Status Client Yes CONTINUOUS In Progress Comments Action Description Undertake a PETS in the health sector. Responsibility Recurrent Frequency Due Date DLI# Status Bank No 14-Jul-2019 Revised Date Comments This action in temporarily suspended until such time as there is more stability in the PFM system. Strengthen MoH internal control environment: (a) analyze compliance gaps between actual practice & MoH internal Action Description control framework (b) identify key measures to strengthen internal control within MoH for budget execution control & financial reporting. Responsibility Recurrent Frequency Due Date DLI# Status Client Yes CONTINUOUS In Progress Comments The MoH reports credible and material complaints regarding fraud and corruption related to the Program to the World Action Description Bank (annually by September 1) Responsibility Recurrent Frequency Due Date DLI# Status Client Yes YEARLY In Progress Comments Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High 11/19/2018 Page 3 of 11 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Substantial Substantial 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 Results PDO Indicators by Objectives / Outcomes The PDO is to improve efficiency in public resource management systems of the health sector in Nepal IN00639633 ►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 Year N/A - target set for Year Value regions over the by LMIS data in year 3 4 4 baseline established in year 3 through the LMIS. Date 15-Jul-2019 15-Sep-2017 28-Sep-2018 15-Jul-2021 Comments IN00639634 ►Percentage of the MoH's annual spending captured by TABUCS (DLI 8) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target MOH reports that Year 2 Value 70% 84% 95% target is on track. Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 15-Jul-2021 Comments IN00639635 ►Percentage of districts which have all facilities reporting annual disaggregated data using DHIS 2 (DLI 10) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0% Not yet due Not yet due 75% Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 15-Jul-2021 11/19/2018 Page 4 of 11 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Comments Intermediate Results Indicators by Results Areas 1. Improved Public Procurement IN00639656 ►Percentage of contracts managed by the LMD through PPMO's online e-procurement portal (DLI 1) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 90% of value of total 0% (no contract is through MOH reports Year 2 contracts managed by Value online eprocurement 81.55% target on track LMD done through developed by PPMO) online eprocurement Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 15-Jul-2021 Comments IN00639659 ►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 Web-based Grievance Annual report on Redressal Mechanism for Year 2 target is being Value Year 2 target: off-track grievances received procurement is not verified. and addressed. established. Date 13-Jan-2017 15-Sep-2017 28-Sep-2018 15-Jul-2021 Comments IN00639662 ►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 basic package of drugs Not based on standard DLR 3.2 achieved while and essential Value Year 2 target-on track specifications DLR 3.3 not achieved equipment based on the use of standard specifications Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 15-Jul-2021 Comments IN00639663 ►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 Value 0.00 N/A N/A warehouses and all district stores of at least two regions. Date 13-Jan-2017 15-Sep-2017 28-Sep-2018 15-Jul-2021 11/19/2018 Page 5 of 11 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Comments IN00639664 ►Installation of the LMIS to produce real-time web-based information (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Installation of LMIS to Real-time web-based MOH reports Year 2 produce real-time web- Value DLR 4.1 achieved LMIS not in place target on track based information in all central warehouses Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 15-Jul-2021 Comments IN00639665 ►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 DLR 4.2 achieved warehouses and district stores and baseline data generated for stock- outs of tracer drugs Date 13-Jan-2017 15-Sep-2017 28-Sep-2018 15-Jul-2021 Comments IN00639666 ►Percentage improvement in EVM score over 2014 baseline (DLI 6) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Average EVM score of Average EVM score of 80% (based on 2018 Value 64%, with two attributes Year 2- target achieved Year 2- target achieved Survey) with any six achieving 80% attributes achieving 80% Date 13-Jan-2017 15-Sep-2017 28-Sep-2018 15-Jul-2020 Comments 2. Improved Financial Management IN00639657 ►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 Not all spending units by MoH and all Year 1 and Year 2 Year 1 and Year 2 Value submitting annual plan departments, divisions, targets achieved. targets achieved. and budget using eAWPB and centers, and 100% decentralized spending units. 11/19/2018 Page 6 of 11 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Date 13-Jan-2017 13-Apr-2017 28-Sep-2018 15-Jul-2021 Comments IN00639660 ►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 Expected 55% of audited institutions achievement this FY. Percentage as derived responding to primary Need to confirm Value from MoH inventory of 86.7% audit queries within 35 corrected baseline of responses in the first year days over percentage 44% by official derived from the MoH communication. inventory of responses of the previous year Date 17-Jul-2017 15-Nov-2017 28-Sep-2018 15-Jul-2021 Comments 3. Improved Reporting and Information Sharing for Enhanced Accountability and Transparency IN00639658 ►DHIS 2 implementation roadmap finalized (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Year 1 and Year 2 Year 1 and Year 2 Plan for roll out of Value No DHIS 2 targets achieved. targets achieved. DHIS 2 finalized Date 13-Jan-2017 15-Sep-2017 28-Sep-2018 15-Jul-2021 Comments IN00639661 ►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 Off track. MOHP reports areas, on availability of No citizen feedback MOH reports Year 2 Year 2 target was drugs and facility- level Value mechanism in place target on track achieved but not yet services and verified. disaggregated by gender available in public domain including on MoH website. Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 15-Jul-2021 Comments Disbursement Linked Indicators DLI_IND_TABLE 11/19/2018 Page 7 of 11 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) ►DLI 1 Percentage of contracts managed by the LMD through PPMO's online e-procurement portal (DLI 1). (Intermediate Outcome, 15,000,000.00, 7%) Baseline Actual (Previous) Actual (Current) July 15, 2021 0% (No Contract is through MOH reports Year 2 Value online e-procurement 81.55% 90% target on track developed by PPMO) Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 -- 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 Comments PPMO. DLI Target 1.3 At least 60% of value of total contracts managed by LMD done through online e- procurement of Year 2- 81.55% (achieved) ►DLI 2 Production and submission of the annual report on grievances received and addressed through a web-based grievance redressal mechanism (DLI 2). (Intermediate Outcome, 11,000,000.00, 18%) Baseline Actual (Previous) Actual (Current) July 15, 2021 Web-based Grievance Guidelines for Grievance Annual report on Year 2 target achieved Value Redressal Mechanism for Redressal mechanism grievances received and being verified procur endo and addressed Date 13-Jan-2017 15-Sep-2017 28-Sep-2018 -- DLR 2.1 Guidelines for Grievance Redressal mechanism endorsed by MOH- Achieved. DLI Target 2.2 Web-based Grievance Redressal Mechanism established and functioning; and training Comments completed for various levels of staff responsible for grievance handling- Achieved and being verified ►DLI 3 Percentage of procurements done by the LMD using standard specifications (DLI 3). (Intermediate Outcome, 14,000,000.00, 29%) Baseline Actual (Previous) Actual (Current) July 15, 2021 MoH reported it has Not based on standard Value endorsed standard 100% for drugs 90% specifications. specificatio Date 13-Jan-2017 13-Apr-2017 28-Sep-2018 -- DLR 3.1 MOH endorses standard specifications for basic package of drugs to be procured by LMD- Achieved DLR 3.2 For Year 2 procurement, 70% of procurement of basic package of free drugs based on the use of standard specifications- 100% Comments DLR 3.3 Verify that the MoH, through a public notification, has endorsed standard specifications for essential equipment procured by the LMD- off track ►DLI 4 Percentage of district stores reporting based on the LMIS (DLI 4). (Intermediate Outcome, 16,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) July 15, 2021 LMIS reports for LMIS in place and Year 5 received LMIS installation process Value LMIS not in place reporting will start in Year from all central and on track 3 all district stores of two regions 11/19/2018 Page 8 of 11 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Date 13-Jan-2017 13-Apr-2017 28-Sep-2018 -- LMIS installation process in two provinces completed. Comments ►DLI 5 Percentage reduction of stock-outs of tracer drugs in district stores (DLI 5). (Outcome, 10,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) July 15, 2021 25% reduction in stock-outs of tracer drugs over the Percentage as evidenced baseline established Value N/A N/A by LMIS data in year 3. in Year 3 in district stores through LMIS for at least two regions Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 -- Comments Not yet due ►DLI 6 Percentage improvement in the EVM score over 2014 baseline (DLI 6). (Intermediate Outcome, 4,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) July 15, 2021 Average EVM Score Average EVM score of of 80% with any 6 Value 64%, with two attributes Year 3 target achieved Year 3 target achieved attributes achieving achi 80% Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 -- Average EVM score of 82% with 4 attributes in EVM score achieving 80%. (target achieved). Comments ►DLI 7 Percentage of the MoH spending entities submitting annual plan and budget using eAWPB (DLI 7). (Intermediate Outcome, 15,000,000.00, 20%) Baseline Actual (Previous) Actual (Current) July 15, 2021 eAWPB used in Year 5 for plan and budget submission by MoH and all Not all spending units Years 1 & 2 targets Value year 2 target achieved departments, submitting annual plan and achieved divisions, centers, and 100% decentralized spending units Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 -- Comments Year 1 & 2 targets achieved and disbursed. ►DLI 8 Percentage of the MoH's annual spending captured by the TABUCS (DLI 8). (Outcome, 20,000,000.00, 20%) 11/19/2018 Page 9 of 11 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) Baseline Actual (Previous) Actual (Current) July 15, 2021 MOH reports that Year 2 Value 70% 84% 95% target is on track Date 13-Jan-2017 13-Apr-2017 28-Sep-2018 -- Year 2 target achieved.. Comments ►DLI 9 Percentage of audited spending units responding to the OAG's primary audit queries within thirty-five (35) days (DLI 9). (Intermediate Outcome, 15,000,000.00, 20%) Baseline Actual (Previous) Actual (Current) July 15, 2021 10 percentage points increase in audited institutions responding to Year 2 target achieved, primary audit Percentage as derived from Year 2-unlikely to be but baseline has been Value queries within MoH inventory of respon achieved corrected which needs mandated 35 days official communication over percentage derived from the MoH inventory of responses of Year 4 Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 -- On track. Need to confirm corrected baseline of 44% by official communication. 270 Cost Centers under the Comments Federal MOPH. Expected 55% achievement this FY. ►DLI 10 Percentage of districts which have all facilities reporting annual disaggregated data using DHIS 2 (DLI 10). (Outcome, 20,000,000.00, 30%) Baseline Actual (Previous) Actual (Current) July 15, 2021 Value 0% Year 2 target achieved Year 2 target achieved 75% Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 -- Comments Year 1 & 2 targets achieved and disbursed ►DLI 11 Operationalization of the citizen feedback mechanisms and systems for public reporting (DLI 11). (Intermediate Outcome, 10,000,000.00, 20%) Baseline Actual (Previous) Actual (Current) July 15, 2021 Citizen feedback reports produced at the end of each No citizen feedback In process of being Value Year 2 DLR-on track pilot, made available mechanism in place. verified on the MoH’s website for the 6 targeted pilots. Date 13-Jan-2017 16-Apr-2018 28-Sep-2018 -- Comments MOHP reports that six pilot areas selected and officials trained on modified social audit and social audits completed. But yet to be verified. 11/19/2018 Page 10 of 11 The World Bank Implementation Status & Results Report Nepal Health Sector Management Reform Program (P160207) 11/19/2018 Page 11 of 11