The World Bank Report No: ISR10080 Implementation Status & Results Burundi Health Sector Development Support (P101160) Public Disclosure Copy Operation Name: Health Sector Development Support (P101160) Project Stage: Implementation Seq.No: 8 Status: ARCHIVED Archive Date: 25-May-2013 Country: Burundi Approval FY: 2009 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 09-Jun-2009 Original Closing Date 30-Dec-2012 Planned Mid Term Review Date 30-Sep-2011 Last Archived ISR Date 28-Oct-2012 Effectiveness Date 30-Sep-2009 Revised Closing Date 31-Dec-2018 Actual Mid Term Review Date 03-Oct-2011 Project Development Objectives Health Sector Development Support (P101160) Project Development Objective (from Project Appraisal Document) To increase the use of a defined package of health services by pregnant women, children under the age of five and couples of reproductive age. Has the Project Development Objective been changed since Board Approval of the Program? � Yes No Component(s) Component Name Component Cost Component 1 - Increased financing for a redefined free package of services 67.55 Component 2 - Strengthening capacity of MSP and entities involved in RBF 17.25 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Highly Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Implementation Status Overview The project continues to advance well both in terms of progress towards achievement of Project Development Objectives (PDOs) and implementation. PDO indicators have improved steadily from its baseline and in general continue to show improvement; however, the most recent update needs to be confirmed once results of the Household survey become available (expected by end May 2013). The project has been significantly scaled up following effectiveness of the first Additional Financing (AF) of US$14.8 million on October 12, 2012 and the second AF of US$ 45 million on April 8, 2013. Financed by the Health Results Innovation Trust Fund (HRITF), the first AF would ensure continuity of the original financing through: (i) support to RBF payments for Page 1 of 7 The World Bank Report No: ISR10080 the health sector with an emphasis on free basic health care focusing on pregnant women and children under-five; and (ii) finance verification activities for the RBF payments. Activities under the first AF have been progressing well and disbursement is on track. The second AF is co-financed by IDA (US$ 25 million) and HRITF (US$ 20 million) and would further expand package of services provided under the RBF program to include nutrition services and family planning. The full package of services including the additional services would be financed until the new project closing date which has been extended from August 31, 2014 to December 31, 2018. Public Disclosure Copy Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Average number of visits to a health provider Number Value 1.68 2.00 by children under the age of 5 Date 31-Dec-2009 31-Dec-2012 31-Aug-2014 Comments Source: Updated value from Data to be updated upon Target updated to reflect the 2009 Pacquete Minimum de completion of the next HH new closing date. Service (PMS) household survey (June 2013). Results (HH) survey. Alternative proxy were expected in March 2013 indicator " number of under- but delayed due to five children curative care administrative issues. visits to hospitals and health centers" (RBF program) Children immunized (number) Number Value 297780.00 341030.00 Date 31-Dec-2009 31-Dec-2012 31-Aug-2014 Comments Source: HMIS report 2009, Data to be updated once Source: HMIS report. Target indicator measured is HMIS report 2012 is validated updated to reflect the new ''children under 12 months (by June 2013). Alternative closing date. against DTP3 /Pentavalent 3 proxy indicator '' children (number)'' . Alternative proxy completely vaccinated'' (RBF indicator is '' children program) has increased from completely vaccinated'' (RBF 319,356 in 2011 to 327,024 in Public Disclosure Copy program) 2012. Correction: HMIS 2011 data after validation is 322,546, (not 341,108) Children immunized - under 12 months against Number Value 297780.00 341030.00 DTP3 (number) Sub Type Date 31-Dec-2009 31-Dec-2012 31-Aug-2014 Breakdown Comments Source: HMIS report 2009, Data to be updated once Source: HMIS report. Target indicator measured is HMIS report 2012 is validated updated to reflect the new ''children under 12 months (by June 2013). closing date. against DTP3 /Pentavalent 3 Page 2 of 7 The World Bank Report No: ISR10080 (number)'' under IDA core indicator. Alternative proxy of RBF program '' children who are completely vaccinated'' is Public Disclosure Copy 25,287. Number of pregnant women living with HIV Number Value 1582.00 2742.00 2894.00 who received antiretrovirals to reduce the risk Date 31-Dec-2009 31-Dec-2012 31-Aug-2014 of Mother To Child Transmission Comments Source: HMIS report 2009. Source: CNLS report 2012 Source: HMIS report Alternative proxy indicator (correction: data from Dec 31, from PBF program is 2011 from CNLS report 2011) ''pregnant women with HIV under ARV treatment'' Coverage of prenatal care services for Percentage Value 59.40 70.00 69.00 pregnant women (at least 3 visits) Date 31-Dec-2009 31-Dec-2012 31-Aug-2014 Comments Source: National Tentative data from 2012 HMIS. Target updated to Reproductive Health program NRHP report. To be revised reflect the new closing date. (NRHP). once validated 2012 HMIS Alternative proxy indicator is data becomes available. ''number of standard prenatal consultations (3per pregnancy) at hospitals and health centers (RBF Program) Pregnant women receiving antenatal care Number Value 415799.00 501262.00 during a visit to a health provider (number) Date 31-Dec-2009 31-Dec-2012 31-Aug-2014 Comments Source: HMIS report 2009. To be reported once validated Source: HMIS report Indicator newly added under 2012 HMIS data becomes AF1. available. Proxy indicator from RBF Program increased from 431,568 in 2011 to 441,924 in 2012. Public Disclosure Copy Percentage of births assisted by skilled Percentage Value 64.40 68.00 67.50 personnel Date 31-Dec-2009 31-Dec-2012 31-Aug-2014 Comments Source: 2009 PMS survey. Tentative data from 2012 Source: HMIS. Target Data from NRHP report 2009 NRHP report. To be revised updated to reflect the new for ''percentage of births once validated 2012 HMIS closing date. taking place in health facilities data becomes available. '' was 56.3%. Alternative proxy indicator is ''number of births occurring at hospitals Page 3 of 7 The World Bank Report No: ISR10080 and health centers based (RBF Program data) Intermediate Results Indicators Public Disclosure Copy Indicator Name Core Unit of Measure Baseline Current End Target Percentage of health facilities that did not run Percentage Value 53.30 59.00 out of essential drugs in the previous three Date 31-Mar-2010 31-Dec-2011 31-Aug-2014 months Comments (1) The source for the above Data to be updated upon Target updated to reflect the is the March 2010 health completion of the next health new closing date, but may be facilities survey (FOSA). It facility survey (October 2013). further adjusted depending on includes hospitals as well as (Correction: alternative proxy the outcomes of the next health centers. (2) Alternative used for Dec 31, 2011 was health facility survey. proxy measures are available 60.8% and not 69.0%) based on the quality checklist evaluation done (every quarter) under the national RBF program, but using different methodologies than for the health facility survey. (More details are given in the Aide Memoire for the Midterm Review.) These alternative measures show percentage values of 34% for health centers and 20.3% for hospitals, in the Aprill-June 2010 quarter (the first quarter of the national RBF program). Percent of public and non-profit health facilities Percentage Value 50.90 99.86 82.00 that are involved in the RBF system Date 31-Mar-2010 31-Dec-2012 31-Aug-2014 Comments Source: March 2010 health Official records from MoH and Target readjusted to reflect facilities survey (FOSA) from the national RBF the reality on the ground. Public Disclosure Copy program. Only 6 health facilities continue to be reported as not offering free package of services. Number of community organizations that have Number Value 0.00 516.00 350.00 been trained and supported by facilitating Date 30-Sep-2009 30-Jun-2012 31-Aug-2014 agencies Comments Source: June 2012 Report Target surpassed. Target value only valid until end 2012 Page 4 of 7 The World Bank Report No: ISR10080 from General Directorate of in line with the original closing Health date of the project. Target to be revised in the next ISR. Percentage of facilities that have had an Percentage Value 48.09 100.00 100.00 Public Disclosure Copy internal verification visit in the previous six Date 31-Mar-2010 31-Dec-2012 30-Aug-2014 months Comments Source: March 2010 health Source: official records from facility survey (FOSA). MoH. "internal" visit is defined here as a visit by a verification team outside of thehealth facility. Percentage of health facilities that have Percentage Value 75.50 83.00 qualified personnel (a least an A2 nurse) in Date 31-Mar-2010 31-Dec-2012 31-Aug-2014 rural areas Comments Source: March 2010 health Data unavailable. To be To be tracked via the next facility survey (FOSA) updated upon completion of health faciliti survey. the next health facility survey (October 2013). Percentage of health facilities that received Percentage Value 36.30 80.00 their payments within the agreed period Date 31-Mar-2010 31-Dec-2012 31-Aug-2014 Comments Source: March 2010 FOSA Data unavailable.To be Target updated to reflect the survey updated upon completion of new closing date. Takes into the next health facility survey consideration some delays (October 2013). recently seen in payment to facilities. Percentage of health facilities that have had an Percentage Value 0.00 142.00 90.00 external verification visit (cumulative) Date 31-Dec-2009 31-Dec-2012 31-Aug-2014 Comments This refers to visits by the Based on report from National Target to be adjusted in the external agency conducting PBF Unit next ISR. external verification (or "counter-verification"). See comments below for the Public Disclosure Copy percentage of health facilities that have had an "internal" verification visit in the previous six months. Data on Financial Performance (as of 18-Apr-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P101160 IDA-H4880 Effective 09-Jun-2009 07-Jul-2009 30-Sep-2009 30-Dec-2012 31-Aug-2014 Page 5 of 7 The World Bank Report No: ISR10080 Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P101160 IDA-H8080 Effective 23-Oct-2012 10-Dec-2012 08-Apr-2013 31-Dec-2018 31-Dec-2018 P101160 TF-12526 Effective 25-Jul-2012 25-Jul-2012 12-Oct-2012 31-Aug-2014 31-Aug-2014 Public Disclosure Copy P101160 TF-13043 Effective 10-Dec-2012 10-Dec-2012 08-Apr-2013 31-Dec-2018 31-Dec-2018 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P101160 IDA-H4880 Effective USD 25.00 25.00 0.00 24.09 1.96 96.00 P101160 IDA-H8080 Effective USD 25.00 25.00 0.00 0.00 24.83 0.00 P101160 TF-12526 Effective USD 14.80 14.80 0.00 6.07 8.73 41.00 P101160 TF-13043 Effective USD 20.00 20.00 0.00 0.00 20.00 0.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation The two additional financing of US$ 14.8 million (first AF, financed by the HRITF) and US$ 45 million (second AF, co-financed by the HRITF and IDA) were declared effective on October 12, 2012 and April 8, 2013, respectively. The first AF will maintain its support to the national RBF program, while the second AF would further expand the scope to include additional services for nutrition and family planning. The World Bank and the Government are working together to start implementing of these new activities. The project closing date has been extended to December 31, 2018 to accommodate the additional funds and ensure sufficient time for implementation. Restructuring History There has been no restructuring to date. Page 6 of 7 The World Bank Report No: ISR10080 Related Projects P126742-Health Sector Development Support - Additional Financing, P131919-Second Additional Financing Burundi Health Sector Development Support Project Public Disclosure Copy Public Disclosure Copy Page 7 of 7