The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Health System Support Project ("KIRA") (P156012) AFRICA EAST | Burundi | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 8 | ARCHIVED on 24-Nov-2020 | ISR42825 | Implementing Agencies: Ministry of Health, MINISTRY OF FINANCE Key Dates Key Project Dates Bank Approval Date: 24-Feb-2017 Effectiveness Date: 20-Jun-2017 Planned Mid Term Review Date: 24-Feb-2020 Actual Mid-Term Review Date: 24-Feb-2020 Original Closing Date: 30-Jun-2021 Revised Closing Date: 30-Jun-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase the use of quality Reproductive, Maternal, Neonatal, Child and Adolescent Health services, and, in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Use of Performance-based Payments to Support the Recipient's Free Health Care (FHC) Program:(Cost $46.00 M) Implementation Support for the FHC program-related activities:(Cost $11.24 M) Strengthening of Newly Integrated FHC Program Service Providers through financing of minor investments/renovations works for CHWs and nursing training schools:(Cost $0.60 M) Contingency Emergency Response Component (CERC):(Cost $0.46 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions Operationalization of the cost containment strategy as part of the implementation of the Free Health Care - Results Based Financing (FHC-RBF): the cost containment strategy has been implemented by health facilities since July 2020. A register has been introduced in health facilities to identify and register beneficiaries of free healthcare (children under 5, pregnant women) who would have other health coverage mechanisms. Targets are also set by facilities. Performance payments for community health workers: the scale-up of community RBF was to be completed in 2021 but, due to insufficient financial resources, only 8 provinces (5 supported by the KIRA project and 3 by CORDAID) out of 18 have started this approach. Community health workers lack of basic inputs for pathologies such as pneumonia and diarrhea. 11/24/2020 Page 1 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Support for the implementation of FHC-RBF: The operational costs of verification and counter-verification of services linked to PBF/free healthcare are mainly supported by the KIRA project. The Government, KFW and the European Union contribute to a lesser extent. Support for paramedical schools: Despite the support of the KIRA project, challenges persist in terms of resources for supervising students in internship, accessing the Internet, etc. Support to community health workers: kits have been purchased for community health workers in 3 provinces (Gitega, Kayanza and Mwaro) but the content of these kits must be completed. A contract is being awarded for this purpose. A virtual WB supervision mission was conducted in October 2020: KIRA project implementation performances were assessed satisfactory. Several points were highlighted:  The mission recommended more regular monitoring of the results framework, in-depth documentation of the results obtained and the implementation of adapted strategies to accelerate progress towards the set objectives;  The mission reminded the Government of the need to move towards better financial sustainability of the FHC-RBF program through, among other things, the diversification of funding sources and the preparation and adoption of a health financing strategy; Additional financing for two years could be mobilized for KIRA subject to the reorganization, as optimal as possible, of the Bank's portfolio in Burundi. At the end of this 2-year period, it is planned to prepare a more comprehensive project for the health sector which will continue to support the FHC-RBF program. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High Substantial Moderate Macroeconomic Substantial Substantial Moderate Sector Strategies and Policies Moderate Substantial Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and Substantial Moderate Moderate Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Moderate Low Low Other High Moderate Moderate Overall Substantial Moderate Moderate Results PDO Indicators by Objectives / Outcomes Increase the use of quality Reproductive, Maternal, Neonatal, Child and Adolescent Health services IN00872613 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target 11/24/2020 Page 2 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Value 0.00 23,093,114.00 25,630,164.00 18,640,000.00 Date 30-Jun-2016 28-Feb-2020 30-Sep-2020 30-Jun-2021 This indicator is a CRI indicator and replaces the original indicator (from PAD) which had the same label Comments: but for which definitions were not aligned with CRI guidelines. IN00872614 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6,315,810.00 6,524,950.00 8,640,000.00 Date 01-Feb-2017 31-Dec-2019 30-Sep-2020 30-Jun-2021 IN00872615 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15,184,097.00 17,386,199.00 8,800,000.00 Date 01-Feb-2017 31-Dec-2019 30-Sep-2020 30-Jun-2021 IN00872636 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,593,207.00 1,719,015.00 1,200,000.00 Date 01-Feb-2017 31-Dec-2019 30-Sep-2020 30-Jun-2021 IN00872637 ►Percentage of pregnant women who received four antenatal care visits within the first 28 gestational weeks (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.35 42.00 42.00 46.00 Date 01-Jan-2016 31-Dec-2019 31-Dec-2019 30-Jun-2021 IN00872638 ►National quality average score of district hospital (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 84.60 87.42 85.00 Date 01-Jan-2016 31-Dec-2019 30-Jun-2020 30-Jun-2021 IN00872639 ►Contraceptive prevalence rate for modern methods (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 35.30 35.20 35.20 41.00 11/24/2020 Page 3 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Date 29-Dec-2017 31-Dec-2018 31-Dec-2018 30-Jun-2021 Latest data available for this indicator is from December 2018. Updated data will be available in June Comments: 2020 according to PNSR. IN00872640 ►Contraceptive prevalence rate among adolescents (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.50 4.90 4.90 12.00 Date 01-Jan-2016 31-Dec-2019 31-Dec-2019 30-Jun-2021 Given the low frequency of PMS / DHS surveys, the PNSR proposed to calculate the indicator using Comments: routine DHIS2 data using utilization rate of contraceptives by adolescents aged 15-19. Intermediate Results Indicators by Components Use of Performance-based Payments to Support the Recipient's Free Health Care (FHC) Program IN00872641 ►Number visits to a health facility for Children under five years of age (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.20 2.50 2.40 2.50 Date 01-Dec-2016 31-Dec-2019 30-Sep-2020 30-Jun-2021 IN00872642 ►Pregnant women receiving antenatal care during a visit to a health provider (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,104,530.00 1,308,809.00 903,254.00 Date 01-Jan-2016 31-Dec-2019 30-Sep-2020 30-Jun-2021 IN00872643 ►Number of years-protection couples for modern methods (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6,282,553.00 6,770,099.00 3,066,611.00 Date 01-Jan-2016 31-Dec-2019 30-Sep-2020 30-Jun-2021 IN00872644 ►Coverage of births attended by qualified personnel (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 77.30 93.96 93.96 85.00 11/24/2020 Page 4 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Date 01-Jan-2016 31-Dec-2019 31-Dec-2019 30-Jun-2021 IN00872645 ►Number of pregnant women on ARV protocol for the prevention of mother-child transmission (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3,885.00 14,571.00 15,367.00 22,430.00 Date 01-Jan-2016 31-Dec-2019 30-Jun-2020 30-Jun-2021 IN00872646 ►Satisfaction rate of beneficiaries on health care delivered by health centers (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 57.43 98.80 82.05 75.00 Date 30-Dec-2016 31-Dec-2019 30-Jun-2020 30-Jun-2021 IN00872647 ►Percentage of public health facilities that offer FHC and use RBF (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 97.00 100.00 100.00 99.00 Date 01-Jan-2016 31-Dec-2019 19-Oct-2020 30-Jun-2021 IN00872648 ►Number of new Family Planning acceptors referred by Community Health Workers and who arrived at the health center (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 202,622.00 223,280.00 194,109.00 Date 01-Jan-2016 29-Nov-2019 30-Sep-2020 30-Jun-2021 IN00872649 ►Number of pregnant women referred for early antenatal care ANC1 (TRIM1) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 195,956.00 218,483.00 81,956.00 Date 01-Jan-2016 29-Nov-2019 30-Sep-2020 30-Jun-2021 IN00872650 ►Total number of children aged 6-59 months tested and referred by community health workers for malnutrition (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 351,781.00 367,086.00 525,908.00 Date 30-Dec-2016 29-Nov-2019 30-Sep-2020 30-Jun-2021 IN00872651 11/24/2020 Page 5 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) ►Children under 2 fully immunized (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 75.00 80.00 82.00 Date 30-Jun-2017 31-Dec-2019 28-Feb-2020 30-Jun-2021 Baseline and current value of the indicator don't use the same source. Need to revise baseline and targets Comments: according to the new definition. IN00872652 ►Grievances registered related to delivery of project benefits that are actually addressed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 25-Feb-2019 28-Feb-2020 19-Oct-2020 30-Jun-2021 Mecanism not yet operational Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P156012 IDA-D1660 Effective USD 50.00 50.00 0.00 48.42 3.50 93% P156012 TF-B0539 Effective USD 8.30 8.30 0.00 3.06 5.24 37% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P156012 IDA-D1660 Effective 24-Feb-2017 23-Mar-2017 20-Jun-2017 30-Jun-2021 30-Jun-2021 P156012 TF-B0539 Effective 15-May-2019 17-Jun-2019 17-Jun-2019 30-Jun-2021 30-Jun-2021 Cumulative Disbursements 11/24/2020 Page 6 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) 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 06-Feb-2020 ,Level 2 Approved on 07-Jul-2020 Related Project(s) P166576-Burundi Health System Support-Additional Financing ,P173252-Health System Support Project (KIRA) Additional Financing 2 11/24/2020 Page 7 of 7