The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Essential Health Services Access Project (P149960) EAST ASIA AND PACIFIC | Myanmar | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2015 | Seq No: 8 | ARCHIVED on 21-Nov-2018 | ISR34382 | Implementing Agencies: Ministry of Health and Sports, Republic of the Union of Myanmar Key Dates Key Project Dates Bank Approval Date: 14-Oct-2014 Effectiveness Date: 08-Apr-2015 Planned Mid Term Review Date: -- Actual Mid-Term Review Date: -- Original Closing Date: 30-Jun-2019 Revised Closing Date: 30-Jun-2019 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to increase coverage of essential health services of adequate quality, with a focus on maternal, newborn and child health (MNCH). 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 (PDO) is to increase coverage of essential health services of adequate quality, with a focus on maternal, newborn and child health (MNCH), and, in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency. Components Table Name Component 1: Strengthening Service Delivery at the Primary Health Care Level:(Cost $84.00 M) Component 2: Systems Strengthening, Capacity Building, and Project Management Support:(Cost $12.57 M) Component 3: Contingent Emergency Response:(Cost $3.43 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 High High Implementation Status and Key Decisions 11/21/2018 Page 1 of 8 The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Component One's (84% of the financing). The implementation progress is satisfactory. The World Bank received the Year 3 DLI report from the Ministry on October 12, which indicated achievement exceeded the targets of 5 of the 7 DLIs (readiness of health facilities, regular flow of health facility funds per formula, outreach visits for antenatal and postnatal care, regular and systematic supervision visits by state/region and township health authorities to the lower levels). As in previous years, the two DLIs with partial achievement are: (i) 108 townships out of the target 140 achieved the DLI4 on inclusive township health plan; and (ii) 88 out of 140 townships achieved DLI7 on skills training of midwives on BEmONC and IMCI. One major challenge townships face in fully achieving DLI4 comes from the difference in interpretation and understanding of ‘inclusiveness’ in the township health planning process. MOHS is addressing this discrepancy by harmonizing and strengthening the numerous township planning tools/templates into a standardized one. The biggest barrier to DLI7 full achievement was due to a delay in the procurement of training manuals, which has now been addressed by the Ministry. All remaining training is expected to be completed in the next six months. Component 2 (16% of the financing). The implementation has picked up momentum to catch up with the lag in previous periods. Since the last IFR, a dedicated unit within the Department of Public Health led by the Director of Planning has been assigned as a focal unit to contact and collect information from individual program units for their work plan and budget under Component 2. The focal unit then compiles the individual plans, submits them for internal departmental review before forwarding to the World Bank for no objection. Procedure-wise, this arrangement has significantly cut down the delay in MOHS internal processing and helped the programs to undertaken implementation of proposed activities in a timely manner. One of the delays in Component 2 implementation in previous period was due to the delay in procurement of training manuals for BEmONC and IMCI and this has now been accomplished by joint efforts of the procurement unit and MRH and CHD program units. Processing ministerial approval for Health Care Waste Management Guidelines/SOP and corresponding training materials are on track. The Ministry has also given more emphasis and attention to improving the service delivery at the grassroots level through policy dialogue and curriculum development on health literacy promotion and community health care model, and conducting more frequent supportive supervision visits from the central units to the frontlines. Continuing improvement in the streamlining of decision making and approval processes for the budgeted workplans, and better information sharing and coordination among different units/departments within the ministry will be essential to maintain and improve the implementation momentum. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- High High Macroeconomic -- Substantial Substantial Sector Strategies and Policies -- Low Low Technical Design of Project or Program -- High High Institutional Capacity for Implementation and Sustainability -- High High Fiduciary -- Substantial Substantial Environment and Social -- High High Stakeholders -- Substantial Substantial Other -- -- -- Overall -- High High Results PDO Indicators by Objectives / Outcomes 11/21/2018 Page 2 of 8 The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Expanded coverage of essential health services, especially for women and children IN00640515 ►Deliveries with skilled birth attendant (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 71.00 76.00 80.00 82.00 Date 01-Jun-2014 30-Jun-2017 03-Sep-2018 30-Jun-2019 IN00640516 ►Deliveries which are followed by adequate postnatal care (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 71.00 71.00 85.00 Date 01-Jun-2014 31-Mar-2017 31-Mar-2017 30-Jun-2019 Based on household survey. Comments: IN00640517 ►Children under 6 months who are being exclusively breast-fed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 24.00 51.00 51.00 40.00 Date 30-Jun-2015 31-Mar-2017 31-Mar-2017 30-Jun-2019 IN00640518 ►Townships in which the township hospital and at least 60% of other Health Facilities have met a minimum readiness level of 14 out of 20 to provide essential MNCH services (Number, Custom, DLI) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 204.00 180.00 Date 01-Jun-2014 02-Oct-2017 03-Oct-2018 31-Dec-2019 Number of townships where the township hospital and at least 60% of other health facilities meet a Comments: minimum readiness level of 14 out of 20 to provide essential MNCH services. Intermediate Results Indicators by Components Strengthening service delivery at the primary health care level IN00640519 ►Township in which township health department have been supervised at least twice in a fiscal year by State/Region Health Department officials using checklist (Number, Custom, DLI) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 160.00 180.00 Date 01-Jun-2014 31-Oct-2017 11-Oct-2018 31-Dec-2019 Number of Townships in which all rural health centers and at least 50% of rural health sub-centers have Comments: been supervised at least twice in the Fiscal Year by THD medical officers using the supervision checklist in the OM IN00640521 11/21/2018 Page 3 of 8 The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) ►Townships in which all rural health centers and atleast 50% of subcenters have been supervised atleast twice in a fiscal year by Township Health Department using checklist (Number, Custom, DLI) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 170.00 180.00 Date 01-Jun-2014 31-Oct-2017 11-Oct-2018 31-Dec-2019 Number of Townships in which the THDs have been supervised at least twice a year by State/Region Comments: Health Department officials using the supervision checklist in the OM. IN00640522 ►Townships in which the township hospital and atleast 80% of other health facilities have received Health Facility Grants in accordance with Project Operations Manual (Number, Custom, DLI) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 321.00 180.00 Date 01-Jun-2014 31-Oct-2017 11-Oct-2018 31-Dec-2019 Number of Townships in which the Township hospital and at least 80% of the other Health Facilities have Comments: received Health Facility Grants in accordance with the OM. IN00640524 ►Townships in which atleast 80% of required number antenatal and postnatal visits and deliveries have been carried out by basic health staff (Number, Custom, DLI) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 168.00 180.00 Date 01-Jun-2014 31-Oct-2017 11-Oct-2018 31-Dec-2019 Number of Townships in which at least 80% of antenatal and postnatal visits and deliveries have been Comments: carried out by basic health staff in accordance with the OM. IN00640526 ►Townships in which at least 60% of midwives have been trained to deliver BeMOC and IMCI (Number, Custom, DLI) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 84.00 88.00 180.00 Date 01-Jun-2014 31-Oct-2017 11-Oct-2018 31-Dec-2019 Number townships with at least 60% midwives trained to deliver Basic Emergency Obstetric and Neonatal Comments: Care (BEmONC) and IMCI. IN00640528 ►Townships in which the Township Health Departments have prepared an integrated and inclusive Township Health Plans (Number, Custom, DLI) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 60.00 108.00 180.00 Date 01-Jun-2014 31-Oct-2017 11-Oct-2018 31-Dec-2019 Number of Townships in which the THDs have prepared an annual integrated and inclusive Health Plan in Comments: accordance with the OM and the CEPF IN00640530 ►Townships where atleast 60% of the health facilities had no stock-out of supplies in the past year. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 11/21/2018 Page 4 of 8 The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Date 01-Jun-2014 31-Oct-2016 31-Oct-2016 30-Jun-2019 Systems Strengthening and Capacity Building IN00640520 ►Service readiness scorecard implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Jun-2014 30-Sep-2015 30-Sep-2015 30-Dec-2015 IN00640523 ►Townships where data quality assessments are carried out (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 180.00 Date 01-Jun-2014 31-Oct-2016 31-Oct-2016 30-Dec-2021 IN00640525 ►Health Care Waste Management guidelines and policy developed and implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Jun-2014 01-Mar-2018 01-Mar-2018 30-Jun-2019 Comments: Health care waste management guidelines and policy developed IN00640527 ►Improved fund flows (recurrent) to front line health facilities--Training on guidelines developed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Jun-2014 01-Sep-2015 01-Sep-2015 01-Apr-2015 IN00640529 ►Improved supervision (supervision standards and checklists developed) (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Jun-2014 30-Sep-2015 30-Sep-2015 31-Dec-2015 IN00640531 ►Communications strategy developed and implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Jun-2014 31-Mar-2016 31-Mar-2016 30-Jun-2019 11/21/2018 Page 5 of 8 The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Communication strengthened ? to improve care-seeking behaviors and to increase transparency and Comments: accountability IN00640532 ►Health Financing Strategy for UHC developed, approved, and communicated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Jun-2014 31-Oct-2017 31-Oct-2017 31-Dec-2018 Comments: Health Financing Strategy for UHC developed, approved and communicated IN00640533 ►Essential Package of Health Services including quality standards defined, costed, approved, and publicly communicated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Jun-2014 31-Oct-2016 31-Oct-2016 31-Mar-2016 Disbursement Linked Indicators IN00640534 ►DLI 1 Townships in which the township hospital and at least 60% of other Health Facilities have met a minimum readiness level of 14 out of 20 to provide essential MNCH services (Number, Outcome, 16,000,000.00, 50.00%) Baseline Actual (Previous) Actual (Current) 2018-2019 Value 0.00 140.00 204.00 180.00 Date -- 10-Aug-2018 10-Aug-2018 -- IN00640535 ►DLI 2 Townships in which the township hospital and atleast 80% of other health facilities have received Health Facility Grants in accordance with Project Operations Manual (Number, Output, 16,000,000.00, 50.00%) Baseline Actual (Previous) Actual (Current) 2018-2019 Value 0.00 140.00 321.00 180.00 Date -- 10-Aug-2018 10-Aug-2018 -- IN00640536 ►DLI 3 Townships in which atleast 80% of required number antenatal and postnatal visits and deliveries have been carried out by basic health staff (Number, Intermediate Outcome, 12,000,000.00, 50.00%) Baseline Actual (Previous) Actual (Current) 2018-2019 Value 0.00 140.00 168.00 180.00 Date -- 10-Aug-2018 10-Aug-2018 -- IN00640537 ►DLI 4 Townships in which the Township Health Departments have prepared an integrated and inclusive Township Health Plans (Number, Output, 8,000,000.00, 50.00%) 11/21/2018 Page 6 of 8 The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Baseline Actual (Previous) Actual (Current) 2018-2019 Value 0.00 93.00 108.00 180.00 Date -- 10-Aug-2018 10-Aug-2018 -- IN00640538 ►DLI 5 Townships in which all rural health centers and atleast 50% of subcenters have been supervised atleast twice in a fiscal year by Township Health Department using checklist (Number, Output, 12,000,000.00, 50.00%) Baseline Actual (Previous) Actual (Current) 2018-2019 Value 0.00 140.00 170.00 180.00 Date -- 10-Aug-2018 10-Aug-2018 -- IN00640539 ►DLI 6 Township in which township health department have been supervised at least twice in a fiscal year by State/Region Health Department officials using checklist (Number, Output, 8,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2018-2019 Value 0.00 140.00 160.00 180.00 Date -- 10-Aug-2018 10-Aug-2018 -- IN00640540 ►DLI 7 Townships in which at least 60% of midwives have been trained to deliver BeMOC and IMCI (Number, Output, 12,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2018-2019 Value 0.00 91.00 88.00 180.00 Date -- 10-Aug-2018 10-Aug-2018 -- Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P149960 IDA-55420 Effective USD 100.00 100.00 0.00 57.59 33.34 63% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P149960 IDA-55420 Effective 14-Oct-2014 05-Feb-2015 08-Apr-2015 30-Jun-2019 30-Jun-2019 Cumulative Disbursements 11/21/2018 Page 7 of 8 The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Restructuring History Level 2 Approved on 12-May-2015 ,Level 1 Approved on 23-Jun-2016 ,Level 2 Approved on 20-Feb-2017 ,Level 2 Approved on 22-Aug-2018 Related Project(s) P160208-Additional Financing: Essential Health Services Access Project 11/21/2018 Page 8 of 8