The World Bank Report No: ISR14259 Implementation Status & Results Mozambique Health Service Delivery (P099930) Public Disclosure Copy Operation Name: Health Service Delivery (P099930) Project Stage: Implementation Seq.No: 12 Status: ARCHIVED Archive Date: 28-Jun-2014 Country: Mozambique Approval FY: 2009 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): MInistry of Health Key Dates Board Approval Date 16-Apr-2009 Original Closing Date 28-Feb-2014 Planned Mid Term Review Date 15-Sep-2011 Last Archived ISR Date 26-Mar-2014 Effectiveness Date 11-Jun-2010 Revised Closing Date 31-Dec-2016 Actual Mid Term Review Date 22-Jun-2012 Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase access to, and utilization of, maternal and child health and nutrition services in target areas in the Recipient's territory. Has the Project Development Objective been changed since Board Approval of the Project? ● Yes No Component(s) Component Name Component Cost Improvement in service delivery. 80.00 Boosting of national malaria control program 15.50 Strategic Planning and Capacity Building 7.40 Project Management and Operating Costs 6.50 Overall Ratings Public Disclosure Copy Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Moderate Implementation Status Overview Project implementation has slowed down slightly during the past 3 months mainly due to bureaucratic bottlenecks related to recruitment and procurement of goods, particularly for the nutrition component where extra focus is needed to initiate activities at district and community levels. However, satisfactory progress has been made in training health staff and community health workers (Agentes Polivalentes Elementares – APEs). The number of APEs trained is now close to the target of 1,100 APEs and the Ministry of Health (MOH) anticipates that the training of all APEs for the three target provinces (Cabo Delgado, Niassa and Nampula) will be completed by September 2014. Preliminary activities in Page 1 of 11 The World Bank Report No: ISR14259 constructing health facilities are underway, yet at a slow pace. It is expected that the health facility construction and rehabilitation of targeted facilities would begin no later than August 2014. The recruitment of nutrition specialists to help manage implementation of the Nutrition component of the project has not yet been completed due to bureaucratic procedures. This Public Disclosure Copy delay has resulted in a slow implementation of the nutrition component of the project. The community based nutrition activities are to be implemented by Non- Government Organizations (NGOs) selected through a competitive process. The selection of the NGOs is about to be finalized, but has taken more time than anticipated to reach the stage of contract signing (expected June 30, 2014). Locations Country First Administrative Division Location Planned Actual Mozambique Provincia de Niassa Provincia de Niassa Mozambique Provincia de Nampula Provincia de Nampula Mozambique Provincia de Cabo Delgado Provincia de Cabo Delgado Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of institutional deliveries Percentage Value 50.80 65.00 65.00 Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Comments The previous indicator The end target is a national reflected a national average. target. Provinces set their It was disaggregated to reflect annual targets each year but the situation in each province. do not have defined multi- Please note that the values annual targets are entered only for each province. The value entered in the main indicator is an arithmetic sum of the respective values in each Public Disclosure Copy province. The end target is a national target. Provinces set their annual targets each year but do not have defined multi- annual targets. Source: MOH HMIS. Cabo Delgado Percentage Value 57.00 73.00 65.00 Sub Type Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Page 2 of 11 The World Bank Report No: ISR14259 Breakdown Comments The target for 2013 was 65% The end target is a national target. Provinces set their annual targets each year but do not have defined multi- Public Disclosure Copy annual targets Nampula Percentage Value 53.00 79.00 65.00 Sub Type Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Breakdown Comments The target for 2013 was 65% The end target is a national target. Provinces set their annual targets each year but do not have defined multi- annual targets Niassa Province Percentage Value 84.00 83.00 65.00 Sub Type Date 31-Dec-2012 31-Dec-2013 31-Dec-2016 Breakdown Comments The baseline data may not The target for 2013 was 65% The end target is a national have been accurate. target. Provinces set their annual targets each year but do not have defined multi- annual targets Percentage of children vaccinated with Percentage Value 45.00 117.30 90.00 DPTHepHib3 in the first year of life in each Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 province Comments The indicator now reflects the The end target is a national MOH indicator which includes target. Provinces set their two more vaccines, namely, annual targets each year but Hepatitis B, and Haemophilus do not have defined multi- influenza B. Inaddition the annual targets. indicator was disaggregated to reflect the coverage by province. The current value entered for this indicator is an average of the coverage of the three provinces. Public Disclosure Copy Cabo Delgado Province Percentage Value 71.00 101.00 90.00 Sub Type Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Breakdown Comments The current coverage is The end target is a national above 100%. This might be target. Provinces set their attributable to weaknesses in annual targets each year but data recording, vaccinations do not have defined multi- done to individuals beyond annual targets. the target group and other causes. It will be necessary to Page 3 of 11 The World Bank Report No: ISR14259 ascertain the causes and determine the real coverage with this intervention. Nampula Province Percentage Value 51.00 103.00 90.00 Public Disclosure Copy Sub Type Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Breakdown Comments The current coverage is The end target is a national above 100%. This might be target. Provinces set their attributable to weaknesses in annual targets each year but data recording, vaccinations do not have defined multi- done to individuals beyond annual targets. the target group and other causes. It will be necessary to ascertain the causes and determine the real coverage with this intervention. Niassa Province Percentage Value 115.00 102.00 90.00 Sub Type Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Breakdown Comments The current coverage is The end target is a national above 100%. This might be target. Provinces set their attributable to weaknesses in annual targets each year but data recording, vaccinations do not have defined multi- done to individuals beyond annual targets. the target group and other causes. It will be necessary to ascertain the causes and determine the real coverage with this intervention. Percentage of pregnant women who received Percentage Value 18.60 32.00 50.00 2nd dose of IPT at antenatal clinics Date 31-Dec-2009 30-Jun-2013 31-Dec-2016 Comments This is a new PDO indicator in From the MOH reports. The The previous indicator accordance with the modified target for the year 2013 was reflected a national average. results framework. The 50%. The combined It was disaggregated to reflect Public Disclosure Copy baseline was obtained from coverage of the three the situation in each province. the preliminary results of the provinces is 32% lower than Please note that the values 2011 DHS referring to the coverage reached in 2012 are entered only for each pregnancies in years (36%). The coverage reported province. The value entered 2009-2010. in June 30, 2013 (34.3%) was in the main indicator is an a half year result. In summary arithmetic sum of the the IPT coverage reduced respective values in each from 36% in 2012 to 32% in province. The end target is a 2013. national target. Provinces set their annual targets each year Page 4 of 11 The World Bank Report No: ISR14259 but do not have defined multi- annual targets. Cabo Delgado Percentage Value 18.60 25.00 50.00 Public Disclosure Copy Sub Type Date 31-Dec-2013 31-Dec-2016 Breakdown Comments The baseline is the national This is the first time the average obtained from the indicator is disaggregated by preliminary results from DHS province 2011 referring to pregnancies in years 2009-2010 Niassa Percentage Value 18.60 26.00 50.00 Sub Type Date 31-Dec-2013 31-Dec-2016 Breakdown Comments The baseline is the national This is the first time the average obtained from the indicator is disaggregated by preliminary results from DHS province 2011 referring to pregnancies in years 2009-201 Nampula Percentage Value 18.60 45.00 50.00 Sub Type Date 31-Dec-2013 31-Dec-2016 Breakdown Comments The baseline is the national This is the first time the average obtained from the indicator is disaggregated by preliminary results from DHS province 2011 referring to pregnancies in years 2009-2010 Direct project beneficiaries Number Value 0.00 779582.00 2151445.00 Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Comments Female beneficiaries Percentage Value 0.00 83.30 80.00 Sub Type Supplemental Percentage of children aged 0-24 months fed Percentage Value 0.00 10.00 Public Disclosure Copy in accordance with all 3 IYCF practices (food Date 31-Dec-2016 diversity, feeding frequency, and consumption Comments The baseline will be done in The baseline will be done in 10 percent increase from the of breast milk or milk) 2014. 2014 baseline. After the baseline the end target will be updated. Intermediate Results Indicators Page 5 of 11 The World Bank Report No: ISR14259 Indicator Name Core Unit of Measure Baseline Current End Target Outreach teams fully operational in Cabo Number Value 0.00 621.00 54.00 Delgado, Nampula, and Niassa Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Public Disclosure Copy Comments Data provided by the Directorate of Planning and Cooperation. The increase in number of outreach team can be justified by the availability of vehicles and funding for fuel, perdiem and other operating costs. Number of Agentes Polivalentes Elementares Number Value 0.00 737.00 1100.00 (APEs) trained (cumulative) Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Comments Some additional APEs are currently undergoing training. By the end of 2014, an additional 298 APEs will complete their training, totaling 1035 APEs trained under the project. Health personnel receiving training (number) Number Value 0.00 189.00 300.00 Date 31-Dec-2009 31-Mar-2014 31-Dec-2016 Comments The above number include all form of training done and recorded by the Department of Human resources. Source: Department of Human Resources of the MOH Health facilities constructed, renovated, and/or Number Value 0.00 0.00 18.00 Public Disclosure Copy equipped (number) Date 31-Dec-2009 14-Feb-2014 31-Dec-2016 Comments The construction will be started in 2014, second semester. Pregnant women receiving first ANC visit Number Value 165917.00 528680.00 Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Comments This indicator capture the total The figure above is a sum of number of women receiving the figures for each province. 1st ante-natal care in health Page 6 of 11 The World Bank Report No: ISR14259 units that have (a) workers that have received training funded by the World Bank or (b) been constructed or Public Disclosure Copy substantially renovated with World Bank funding. This is a measureof contribution, and it is not necessary to make a calculation to estimate a pro rata World Bank attribution, based on financial contribution to each health center. This figure be a pro- rata calculation based on the total number of women receiving a1st ante-natalcare in the province, and the number of facilities in the province that have received support from the World Bank (i.e., if 75% of health units have received some support, then 75% of the total number of women who received 1st ante-natal care will be counted). Targets were calculated from Demographic Projection – 2011 assuming coverage of 95%. Cabo Delgado Number Value 118126.00 115994.00 85853.00 Sub Type Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Breakdown Comments The target for 2013 was set at The target is lower than the 85,853. baseline after adjusting the denominator on the basis of Public Disclosure Copy the official demographic data Nampula Number Value 267517.00 322868.00 217338.00 Sub Type Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Breakdown Comments The target for 2013 has been The target is lower than the set to 217,338. baseline after adjusting the denominator on the basis of the official demographic data Niassa Number Value 112195.00 89818.00 80041.00 Sub Type Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Page 7 of 11 The World Bank Report No: ISR14259 Breakdown Comments The target for 2013 has been The target is lower than the set to 80,041 baseline after adjusting the denominator on the basis of the official demographic data Public Disclosure Copy Children receiving a dose of vitamin A Number Value 194521.00 1226782.00 1065594.00 Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Comments Children aged 6-59 months. The actual figure for 2013 is a The end target is a sum of the The baseline reflects the sum of the three provinces. targets of the three provinces. average baseline figure for The target has been each province surpassed. Cabo Delgado Number Value 178490.00 296473.00 240113.00 Sub Type Date 31-Dec-2009 30-Jun-2013 31-Dec-2016 Breakdown Comments The target for 2013 has been set to 235, 811 Nampula Number Value 185879.00 770547.00 625488.00 Sub Type Date 31-Dec-2009 30-Jun-2013 31-Dec-2016 Breakdown Comments The target for 2012 has been at 609,797 Niassa Number Value 219195.00 254129.00 200993.00 Sub Type Date 31-Dec-2009 30-Jun-2013 31-Dec-2013 Breakdown Comments The target for 2012 has been set at 193,178 Number of children under 1 year of age fully Number Value 81848.00 250902.00 243264.00 immunized Date 31-Dec-2009 31-Dec-2013 31-Dec-2016 Comments The figure reflect the sum for The figure reflects the The end target is a sum of the each province average number vaccinated in number of each province the three provinces. The figure from June 30, 2014 is not correct because it only reflects the data of one Public Disclosure Copy province only. The target for 2013 was surpassed. Cabo Delgado Number Value 62412.00 58428.00 54904.00 Sub Type Date 31-Dec-2012 31-Dec-2013 31-Dec-2016 Breakdown Comments The figure in June 30 represented half year realization. Nampula Number Value 150427.00 143270.00 143024.00 Page 8 of 11 The World Bank Report No: ISR14259 Sub Type Date 31-Dec-2012 31-Dec-2013 31-Dec-2013 Breakdown Comments Niassa Number Value 32702.00 49204.00 45346.00 Public Disclosure Copy Sub Type Date 31-Dec-2009 31-Dec-2013 31-Dec-2013 Breakdown Comments Number of Volunteers functional (cumulative) Number Value 0.00 0.00 21000.00 Date 31-Mar-2013 31-Mar-2013 31-Dec-2016 Comments The nutrition additional financing has been in implementation since June 21, 2013 with on-going preparatory works. The implementation of the community based nutrition activities is expected to commence second quarter of 2014. Percentage of children aged 0-24 months Percentage Value 0.00 0.00 80.00 attended at least 1 Growth Monitoring and Date 31-Mar-2013 14-Feb-2014 31-Dec-2016 Promotion services during the 2 preceding Comments The nutrition additional months,% who are female financing has been in implementation since June 21, 2013 with on-going preparatory works. The implementation of the community based nutrition activities is expected to commence second quarter of 2014. Percentage of children aged 6-24 months Percentage Value 0.00 0.00 80.00 received at least 60 sachets of micronutrient Date 31-Mar-2013 14-Feb-2014 31-Dec-2016 Public Disclosure Copy powder (MNP) during the 2 preceding months, Comments The nutrition additional %who are female financing has been in implementation since June 21, 2013 with on-going preparatory works. The implementation of the community based nutrition activities is expected to commence second quarter of 2014. Page 9 of 11 The World Bank Report No: ISR14259 Percentage of pregnan women received a Percentage Value 0.00 complete dose of IFA tablets Date 31-Mar-2013 14-Feb-2014 31-Dec-2016 Comments No baseline available at The nutrition additional 20% increase from baseline Public Disclosure Copy appraisal. The target will be financing has been in set after the baseline survey implementation since June is done. 21, 2013 with on-going preparatory works. The implementation of the community based nutrition activities is expected to commence second quarter of 2014. Data on Financial Performance (as of 09-Jun-2014) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P099930 IDA-45820 Effective 16-Apr-2009 15-Jul-2009 11-Jun-2010 28-Feb-2014 31-Dec-2016 P099930 IDA-51940 Effective 24-Jan-2013 25-Mar-2013 21-Jun-2013 31-Dec-2016 31-Dec-2016 P099930 TF-58155 Closed 21-Sep-2007 21-Sep-2007 21-Sep-2007 31-Dec-2009 31-Dec-2009 P099930 TF-96375 Closed 19-Mar-2010 24-Mar-2010 24-Mar-2010 30-Apr-2013 31-Jul-2013 P099930 TF-96399 Effective 19-Mar-2010 24-Mar-2010 24-Mar-2010 28-Feb-2014 28-Feb-2015 P099930 TF-96505 Effective 15-Apr-2010 19-Apr-2010 19-Apr-2010 28-Feb-2014 31-Jan-2016 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P099930 IDA-45820 Effective USD 44.60 44.60 0.00 19.10 27.07 43.00 P099930 IDA-51940 Effective USD 37.00 37.00 0.00 7.72 29.56 21.00 P099930 TF-58155 Closed USD 1.15 0.18 0.97 0.18 0.00 100.00 P099930 TF-96375 Closed USD 7.86 7.53 0.33 7.53 0.00 100.00 Public Disclosure Copy P099930 TF-96399 Effective USD 3.29 3.29 0.00 2.00 1.29 61.00 P099930 TF-96505 Effective USD 15.18 15.18 0.00 7.02 8.49 46.00 Disbursement Graph Page 10 of 11 The World Bank Report No: ISR14259 Public Disclosure Copy Key Decisions Regarding Implementation N/A Restructuring History There has been no restructuring to date. Related Projects P125477-Mozambique Nutrition Additional Financing Public Disclosure Copy Page 11 of 11