The World Bank Report No: ISR11175 Implementation Status & Results Burundi Health Sector Development Support (P101160) Public Disclosure Copy Operation Name: Health Sector Development Support (P101160) Project Stage: Implementation Seq.No: 9 Status: ARCHIVED Archive Date: 05-Oct-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 25-May-2013 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 ofreproductive 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 Satisfactory Highly Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Implementation Status Overview The project continues to advance well both in terms of progress towards achievement of Project Development Objectives (PDOs) and implementation. Preliminary results of the 2012 Household survey became available in mid -June showing a significant improvement in the key indicators when compared to the last Household survey conducted in 2009. The positive progress of these indicators would justify an upgrade from ‘satisfactory’ to ‘highly satisfactory’ of the project progress towards achievement of PDO. Implementation of the first Additional Financing (AF), intended to ensure continuity of the original financing through: (i) support to RBF payments for 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, is on track. The second AF Page 1 of 6 The World Bank Report No: ISR11175 which became effective on April 8, 2013 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 2.20 2.00 by children under the age of 5 Date 31-Dec-2009 15-Jul-2013 31-Aug-2014 Comments Source: Updated value from End target achieved. Updated Target updated to reflect the 2009 Paquet Minimum de data from 2012 HH Survey new closing date. Service (PMS 1) household (PMS 2). (HH) survey. Alternative proxy indicator " number of under- five children curative care visits to hospitals and health centers" (RBF program) Children immunized (number) Number Value 297780.00 336362.00 341030.00 Date 31-Dec-2009 15-Jun-2013 31-Aug-2014 Comments Source: HMIS report 2009, Updated data will be Source: HMIS report. Target indicator measured is confirmed once the 2012 updated to reflect the new ''children under 12 months HMIS report is validated. closing date. against DTP3 /Pentavalent 3 However, as a proxy (number)'' . Alternative proxy indicator, the results of HH indicator is '' children survey shows a slight completely vaccinated'' (RBF increase in the indicator program) ''Children completely vaccinated'', from 65.4% in Public Disclosure Copy 2009 to 70.3% in 2012. Children immunized - under 12 months against Number Value 297780.00 333298.00 341030.00 DTP3 (number) Sub Type Date 31-Dec-2009 15-Jun-2013 31-Aug-2014 Breakdown Comments Source: HMIS report 2009, Updated data will be Source: HMIS report. Target indicator measured is confirmed once the 2012 updated to reflect the new ''children under 12 months HMIS report is validated. closing date. against DTP3 /Pentavalent 3 Data from the HH survey (number)'' under IDA core shows a slight increase: from indicator. Alternative proxy of Page 2 of 6 The World Bank Report No: ISR11175 RBF program '' children who 86.8%in 2009 to 87.1% in are completely vaccinated'' is 2012. 25,287. Number of pregnant women living with HIV Number Value 1582.00 2742.00 2894.00 Public Disclosure Copy 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 from PBF program is ''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 reflect the new closing date. (NRHP). confirmed once validated Alternative proxy indicator is 2012 HMIS report becomes ''number of standard prenatal available. consultations (3per pregnancy) at hospitals and health centers (RBF Program) Pregnant women receiving antenatal care Number Value 415799.00 461577.00 501262.00 during a visit to a health provider (number) Date 31-Dec-2009 15-Jun-2013 31-Aug-2014 Comments Source: HMIS report 2009. To be confirmed once Source: HMIS report Indicator newly added under validated 2012 HMIS data AF1. becomes available. Proxy indicator from RBF Program increased from 431,568 in 2011 to 441,924 in 2012. Percentage of births assisted by skilled Percentage Value 64.40 81.60 67.50 personnel Date 31-Dec-2009 15-Jun-2013 31-Aug-2014 Public Disclosure Copy Comments Source: 2009 PMS survey. End target achieved. Updated Source: HMIS. Target Data from NRHP report 2009 data from 2012 HH Survey. updated to reflect the new for ''percentage of births Significant increase from closing date. taking place in health facilities 64.4% in 2009 HH survey. '' was 56.3%. Alternative proxy indicator is ''number of births occurring at hospitals and health centers based (RBF Program data) Intermediate Results Indicators Page 3 of 6 The World Bank Report No: ISR11175 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 Public Disclosure Copy 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 the outcomes of the next health centers. (2) Alternative health facility survey. proxy measures are available 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 99.26 82.00 that are involved in the RBF system Date 31-Mar-2010 15-Jun-2013 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. program. 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 Public Disclosure Copy from General Directorate of value only valid until end 2012 Health in line with the original closing 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 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 Page 4 of 6 The World Bank Report No: ISR11175 as a visit by a verification team outside of thehealth facility. Percentage of health facilities that have Percentage Value 75.50 83.00 Public Disclosure Copy 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). Number of health facilities that have had an Number Value 0.00 142.00 90.00 external verification visit (cumulative) Date 31-Mar-2013 31-Dec-2012 31-Aug-2014 Comments Data on Financial Performance (as of 27-Aug-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 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 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 24.29 1.76 97.00 P101160 IDA-H8080 Effective USD 25.00 25.00 0.00 0.00 25.09 0.00 P101160 TF-12526 Effective USD 14.80 14.80 0.00 7.08 7.72 48.00 P101160 TF-13043 Effective USD 20.00 20.00 0.00 0.00 20.00 0.00 Public Disclosure Copy Disbursement Graph Page 5 of 6 The World Bank Report No: ISR11175 Public Disclosure Copy Key Decisions Regarding Implementation The two additional financing of US$ 14.8 million (first AF) and US$ 45 million (second AF) were declared effective on October 12, 2012 and April 8, 2013, respectively. Implementation of the first AF is ongoing and will maintain its support to the national RBF program. The second AF would further expand the scope to include additional services for nutrition and family planning. The Government, the World Bank and other partners involved are working together to accelerate the process of implementation. The project closing date has been extended from August 31, 2014 to December 31, 2018 in view of accommodating the additional funds. Restructuring History There has been no restructuring to date. Related Projects P126742-Health Sector Development Support - Additional Financing, P131919-Second Additional Financing Burundi Health Sector Development Support Project Public Disclosure Copy Page 6 of 6