The World Bank Report No: ISR13015 Implementation Status & Results Burundi Health Sector Development Support (P101160) Public Disclosure Copy Operation Name: Health Sector Development Support (P101160) Project Stage: Implementation Seq.No: 10 Status: ARCHIVED Archive Date: 26-Mar-2014 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 05-Oct-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 the Ministry of Public Health and entities involved in RBF 17.25 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Highly Satisfactory Highly Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Implementation Status Overview The final results of the 2012 Household survey were validated on November 29, 2013 showing a significant improvement in the key indicators when compared with the last Household survey conducted in 2009. The positive progress of these indicators would justify the rating of Highly Satisfactory with regard to progress towards achievement of PDO. Implementation of the national PBF program nevertheless faced some difficulties mainly due to the financing deficit of the overall Program caused by an imbalance between expenditures that have been underestimated and the funding that has been overestimated. The government is in discussion with the development partners (DPs) to address this issue. The rating of overall implementation progress (IP) has therefore been downgraded to Moderately Satisfactory but it will be reviewed again when the issue of national PBF Page 1 of 7 The World Bank Report No: ISR13015 budget is addressed. The project is currently implementing the first Additional Financing (AF) of US$ 14.8 million (HRITF), intended to support PBF payments for the health sector with an emphasis on free basic health care focusing on pregnant women and children under-five. In addition, the second AF of US$45 million (co-financed by IDA US$25 million equivalent and HRITF US Public Disclosure Copy $20 million) which became effective on April 8, 2013 aims to further expand the package of services provided under the PBF 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 of December 31, 2018. With the effectiveness of the second AF, the PDO has been modified 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'' to reflect an enlarged target group for the family planning activities. The new PDO indicators and intermediate outcome indicators have been added to this ISR to also measure the progress related to nutrition and family planning. 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 29-Nov-2013 31-Dec-2018 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 II). (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 336392.00 365561.00 Date 31-Dec-2009 31-Aug-2013 31-Dec-2018 Comments Source: HMIS report 2009, 2012 HMIS report is Source: HMIS report Public Disclosure Copy indicator measured is validated and value ''children under 12 months confirmed. against DTP3 /Pentavalent 3 (number)'' . Alternative proxy indicator is '' children completely vaccinated'' (RBF program) 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 Page 2 of 7 The World Bank Report No: ISR13015 Breakdown Comments Source: HMIS report 2009, Updated data will be Source: HMIS report. This indicator measured is confirmed once the 2012 indicator will not be updated ''children under 12 months HMIS report is validated. as it was eliminated in the first against DTP3 /Pentavalent 3 Data from the HH survey AF (effectiveness date Public Disclosure Copy (number)'' as DTP3 is no shows a slight increase: from October 2012). longer used in Burundi since 86.8%in 2009 to 87.1% in 2006 but cannot modify the 2012. wording as it is a core indicator. Alternative proxy of RBF program '' children who are completely vaccinated'' is 25,287. Number of pregnant women living with HIV Number Value 1582.00 2742.00 2710.00 who received antiretrovirals to reduce the risk Date 31-Dec-2009 31-Dec-2012 31-Dec-2018 of Mother To Child Transmission Comments Source: HMIS report 2009. Source: CNLS report 2012 Source: HMIS report. Target Alternative proxy indicator will be revisited during mid- from PBF program is term review (MTR) in 2015. ''pregnant women with HIV under ARV treatment'' Coverage of prenatal care services for Percentage Value 59.40 61.00 70.50 pregnant women (at least 3 visits) Date 31-Dec-2009 31-Aug-2013 31-Dec-2018 Comments Source: National HMIS 2012 routine data was Source: HMIS Reproductive Health program validated and the value was (NRHP). reduced to 61%.NRHP no Alternative proxy indicator is longer collects this data in ''number of standard prenatal parallel and uses the consultations (3per information provided by HMIS. pregnancy) at hospitals and health centers (RBF Program) Pregnant women receiving antenatal care Number Value 415799.00 461577.00 537318.00 during a visit to a health provider (number) Date 31-Dec-2009 31-Aug-2013 31-Dec-2018 Comments Source: HMIS report 2009. HMIS report validated and Source: HMIS Public Disclosure Copy Indicator newly added under value confirmed. AF1. Percentage of births assisted by skilled Percentage Value 64.40 78.40 69.00 personnel Date 31-Dec-2009 29-Nov-2013 31-Dec-2018 Comments Source: 2009 PMS survey. End target achieved. Updated Source: Household survey Data from NRHP report 2009 data from 2012 HH Survey for ''percentage of births (PMS II) taking place in health facilities '' was 56.3%. Alternative Page 3 of 7 The World Bank Report No: ISR13015 proxy indicator is ''number of births occurring at hospitals and health centers based (RBF Program data) Public Disclosure Copy Direct project beneficiaries Number Value 0.00 2027795.00 2273188.00 Date 30-Nov-2013 31-Dec-2018 Comments Source: HMIS (pregnant The target direct project women calculated at 5.0% of beneficiaries are those total population; children eligible for the country's Free under five calculated at 17.9% Health Care program; (i.e. of total population). pregnant women and children under five); the program covers nationwide. Female beneficiaries Percentage Value 0.00 1246368.00 1368232.00 Sub Type Supplemental Contraceptive prevalence rate Percentage Value 19.80 31.70 24.00 Date 31-Dec-2009 30-Nov-2013 31-Dec-2018 Comments Source: 2012 Household Source: Household survey. survey (PMS II) Target to be revisited during MTR. Pregnant/lactating women, adolescent girls Number Value 0.00 0.00 0.00 and/or children under age five-reached by Date 31-Dec-2009 31-Dec-2009 basic nutrition services (number) Comments This indicator is not included This indicator is not included This indicator is not included in the project Result in the project Result in the project Result Framework Framework Framework Children between the age of 6 and 59 months Number Value 1265275.00 0.00 1709804.00 receiving Vitamin A supplementation (number) Sub Type Date 31-Dec-2009 31-Dec-2018 Breakdown Comments Source: HMIS and Campaign Data not yet available. To be data. Newly added with AF 2. updated during the next Public Disclosure Copy supervision. Children under age five treated for moderate or Number Value 87170.00 0.00 93500.00 severe acute malnutrition (number) Sub Type Date 31-Dec-2009 31-Dec-2018 Breakdown Comments HMIS, indicator newly added Data not yet available, to be with AF 2 updated during the next supervision mission Intermediate Results Indicators Page 4 of 7 The World Bank Report No: ISR13015 Indicator Name Core Unit of Measure Baseline Current End Target Percentage of health facilities that did not run Percentage Value 53.30 60.00 out of essential drugs in the previous three Date 31-Mar-2010 31-Dec-2011 31-Dec-2018 Public Disclosure Copy months Comments (1) The source for the above This indicator has dropped Target updated to reflect the is the March 2010 health significantly compared to the second AF. facilities survey (FOSA). It previous health facility survey includes hospitals as well as in 2010 due to reduction in health centers. (2) Alternative the number of essential drugs proxy measures are available evaluated (10 drugs were based on the quality checklist evaluated in 2010 whereas in evaluation done (every 2012 23 were evaluated at quarter) under the national health facility and 55 in district RBF program, but using hospitals). 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 85.00 offering the free package of services through Date 31-Mar-2010 15-Jun-2013 31-Dec-2018 the RBF system Comments Source: March 2010 health Official records from MoH and Target updated to reflect the facilities survey (FOSA) from the national RBF second AF. program. 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 30-Nov-2013 31-Dec-2018 months Comments Source: March 2010 health Source: official records from Public Disclosure Copy facility survey (FOSA). MoH. "internal" visit is defined here as a visit by a verification team outside of thehealth facility. Page 5 of 7 The World Bank Report No: ISR13015 Percentage of health facilities that have Percentage Value 75.50 77.90 83.00 qualified personnel (at least an A2 nurse) in Date 31-Mar-2010 29-Nov-2013 31-Dec-2018 rural areas Comments Source: March 2010 health Data unavailable. To be Public Disclosure Copy facility survey (FOSA) updated upon completion of the health facility survey. Number of health facilities that have had an Number Value 0.00 164.00 150.00 external verification visit (cumulative) Date 31-Mar-2013 30-Nov-2013 31-Dec-2018 Comments Source: official records from Target to be revisited during MoH the MTR. Births (deliveries) attended by skilled health Number Value 0.00 802908.00 3038901.00 personnel (number) Date 31-Dec-2009 30-Nov-2013 31-Dec-2018 Comments Source: HMIS Source: HMIS Number of couple-years of contraceptive Number Value 228082.00 447274.00 protection using modern methods Date 31-Dec-2009 31-Dec-2018 Comments Source: HMIS, Indicator Source: HMIS. newly added with AF 2. Data on Financial Performance (as of 05-Mar-2014) 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 Public Disclosure Copy P101160 IDA-H4880 Effective USD 25.00 25.00 0.00 25.57 0.52 102.00 P101160 IDA-H8080 Effective USD 25.00 25.00 0.00 0.93 24.55 4.00 P101160 TF-12526 Effective USD 14.80 14.80 0.00 12.36 2.44 83.00 P101160 TF-13043 Effective USD 20.00 20.00 0.00 0.00 20.00 0.00 Disbursement Graph Page 6 of 7 The World Bank Report No: ISR13015 Public Disclosure Copy Key Decisions Regarding Implementation The two AFs 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 PBF 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 implementation. In parallel to support the expanded nutrition focus of the project, the government and the World Bank have prepared a PBF nutrition Impact Evaluation Concept Note which was approved by the World Bank management in February 2014. Restructuring History There has been no restructuring to date. Related Projects Public Disclosure Copy P126742-Health Sector Development Support - Additional Financing, P131919-Second Additional Financing Burundi Health Sector Development Support Project Page 7 of 7