The World Bank Report No: ISR5127 Implementation Status & Results Afghanistan Afghanistan - Strengthening Health Activities for the Rural Poor (SHARP) (P112446) Public Disclosure Copy Operation Name: Afghanistan - Strengthening Health Activities for the Rural Project Stage: Implementation Seq.No: 6 Status: ARCHIVED Archive Date: 06-Jun-2011 Poor (SHARP) (P112446) Country: Afghanistan Approval FY: 2009 Product Line: IBRD/IDA Region: SOUTH ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of Public Health Key Dates Board Approval Date 24-Mar-2009 Original Closing Date 30-Sep-2013 Planned Mid Term Review Date 30-Jun-2011 Last Archived ISR Date 06-Jun-2011 Effectiveness Date 22-Apr-2009 Revised Closing Date 30-Sep-2013 Actual Mid Term Review Date 02-Oct-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) To support the Government in achieving the goal of the Health and Nutrition Sector Strategy 2009-2013 to "contribute to improving the health and nutritional status of the people of Afghanistan, with a greate focus on women and children and undeserved areas of the country". Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Sustaining and strengthening the BPHS 19.00 Strengthening the delivery of EPHS 1.00 Strengthening MOPH stewardship functions 10.00 Results Based Financing (RBF) 12.00 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Implementation Status Overview Overall project performance and progress toward the PDO is rated as Satisfactory, with most of the PDO level indicators estimated to achieve the agreed targets. The Mid-term review of the project indicates that the overall access and coverage to basic services has increased with almost 85 percent of the population now living in districts which now have service providers being financed to deliver a basic package of health services. Health Management Information System data shows mixed results with increasing coverage of Page 1 of 5 The World Bank Report No: ISR5127 deliveries attended by skilled attendance and DPT3 coverage, TB treatment success rate has been maintained and number of current users of family planning has also increased but coverage of antenatal care has declined. Implementation performance since the MTR is now rated satisfactory. Service delivery performance of implementing partner NGOs and SM provinces had declined in terms of Public Disclosure Copy quality of care and coverage of services. However, as a result of actions taken, service delivery performance of PPA NGOs and SM provinces is showing reversing trends and improvements in key performance indicators except for antenatal care and contraceptive use. The improvement has been a result of a detailed review of performance by the Ministry of Public Health and Grant and Contract Management Unit with implementing partners (Non-Government Organizations, Ministry of Public Health-Strengthening Mechanism Unit and Provincial Health Directors). The resulting province specific action plans are being implemented with enhanced monitoring. Continuing dialogue between MOPH and implementing partners is stimulating the improving trends in performance. In addition, after initial delays, implementation of EPHS in PPA and SM provinces and Urban BPHS are have started to make good progress. However, slow progress is being made in integrating Mental Health and Nutrition in the revised BPHS. The 2012 Health Sector Strategic Planning Retreat was organized by the MOPH in January 2012 which has defined and laid out priorities for implementation of the Ministry's Strategic Plan (2011-2015). The team has initiated dialogue with the Ministry and European Union for the next phase of support for the health sector to be approved in 2013. Locations Country First Administrative Division Location Planned Actual Afghanistan Wilayat-e Wardak Wilayat-e Wardak Afghanistan Wilayat-e Sar-e Pul Wilayat-e Sar-e Pul Afghanistan Wilayat-e Samangan Wilayat-e Samangan Afghanistan Wilayat-e Parwan Wilayat-e Parwan Afghanistan Wilayat-e Nimroz Wilayat-e Nimroz Afghanistan Wilayat-e Kapisa Wilayat-e Kapisa Afghanistan Kabul Wilayat-e Kabul Afghanistan Helmand Wilayat-e Helmand Afghanistan Farah Wilayat-e Farah Afghanistan Wilayat-e Balkh Wilayat-e Balkh Public Disclosure Copy Afghanistan Badghis Wilayat-e Badghis Afghanistan Panjshir Panjshir Results Project Development Objective Indicators Page 2 of 5 The World Bank Report No: ISR5127 Indicator Name Core Unit of Measure Baseline Current End Target Pregnant women receiving antenatal care Number Value 0.00 131911.00 119127.00 during a visit to a health provider Date 01-Jul-2009 15-Dec-2011 31-Mar-2013 Public Disclosure Copy Comments Based on 32% coverage Based on 60% coverage 50% ANC coverage (based (2006 Household Survey) and (AMS 2010) and population on an estimate of 238,255 on a population estimate of estimate of 219,852 pregnant pregnant women) 219,852 pregnant women (4% women (4% of the total of the total population inthe population in the intervention intervention area as per CSO area as per CSO statistics statistics 2008-9). The 2008-9). The total number of baseline number pregnant women receiving ANC is women receiving ANC is 131911. 70,353 Children immunized Number Value 0.00 94536.00 142953.00 Date 31-Dec-2006 10-Oct-2009 31-Mar-2013 Comments DPT3 coverage was 34% in DPT3 coverage was 43% 60% is the 2013 target. The 2006. The numeric value (2008 NRVA). The numeric numeric value is based on the (74750) is based on the value (94536) is based on 4% estimated population in the estimated population in the of population in the provinces financed by the provinces financed by the intervention area as per CSO Bank. Bank. statistics 2008-9). Update not available, likely to be available in March 2012 Number of consultations per person per year Number Value 0.90 1.23 1.40 Date 31-Dec-2007 15-Dec-2011 31-Mar-2013 Comments Intermediate Results Indicators Public Disclosure Copy Page 3 of 5 The World Bank Report No: ISR5127 Indicator Name Core Unit of Measure Baseline Current End Target People with access to a basic package of Number Value 4671600.00 4671855.00 5062917.00 health, nutrition, or population services Date 01-Jul-2009 10-Oct-2009 31-Mar-2013 Public Disclosure Copy Comments 85% of the population has 85% of the population is living A target was not discussed access to BPHS. The in the districts where the with authorities during project numerical value has been implementation of BPHS has preparation. The target derived from an estimate of been contracted and have presented here is based on 5,496,300 population in 11 access to BPHS. The the maintenance of a 85% Bank financed provinces (as numerical value has been BPHS coverage throughout per CSO Afghanistan. derived from an estimate of the project. 5,496,300 population in 11 Bank financed provinces (as per CSO Afghanistan). Update not available, likely to be available in March 2012 Births attended by skilled attendants Percentage Value 18.90 34.00 60.00 Date 31-Dec-2006 15-Dec-2011 31-Mar-2013 Comments AHS 2006 (Percentage) Based on AMS 2010 (percentage) TB Treatment Success Rate Percentage Value 85.00 89.00 90.00 Date 31-Dec-2008 04-Oct-2011 31-Mar-2013 Comments HMIS 2008 (percentage) HMIS 2011 (percentatge) Target in percentage and is expected to be greater than 90% by end of the project) Score on the balance scorecard examining Number Value 70.00 70.40 80.00 quality of care in health facilities Date 31-Dec-2007 04-Oct-2011 31-Mar-2013 Comments 2010 Balance Scorecard (Johns Hopkins University) Update likely to be available in March 2012 Public Disclosure Copy Data on Financial Performance (as of 21-Feb-2012) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P112446 IDA-H4690 Effective 24-Mar-2009 09-Apr-2009 22-Apr-2009 30-Sep-2013 P112446 IDA-H5810 Effective 02-Jun-2010 27-Jun-2010 05-Aug-2010 30-Sep-2013 P112446 TF-95691 Effective 20-Dec-2009 20-Dec-2009 20-Dec-2009 30-Sep-2013 P112446 TF-96362 Effective 11-Apr-2010 11-Apr-2010 11-Apr-2010 30-Sep-2013 Disbursements (in Millions) Page 4 of 5 The World Bank Report No: ISR5127 Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P112446 IDA-H4690 Effective USD 30.00 30.00 0.00 30.48 0.44 102.00 P112446 IDA-H5810 Effective USD 49.00 49.00 0.00 15.98 33.75 33.00 Public Disclosure Copy P112446 TF-95691 Effective USD 11.00 11.00 0.00 2.50 9.50 23.00 P112446 TF-96362 Effective USD 22.00 22.00 0.00 26.29 19.71 120.00 Disbursement Graph Key Decisions Regarding Implementation None Restructuring History Public Disclosure Copy There has been no restructuring to date. 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