The World Bank Report No: ISR4410 Implementation Status & Results Ethiopia ET-Ethiopia Nutrition (FY08) (P106228) Public Disclosure Copy Operation Name: ET-Ethiopia Nutrition (FY08) (P106228) Project Stage: Implementation Seq.No: 7 Status: ARCHIVED Archive Date: Country: Ethiopia Approval FY: 2008 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Federal Ministry of Health Key Dates Board Approval Date 29-Apr-2008 Original Closing Date 07-Jan-2014 Planned Mid Term Review Date 21-Nov-2011 Last Archived ISR Date 26-Mar-2011 Effectiveness Date 10-Sep-2008 Revised Closing Date 07-Jan-2014 Actual Mid Term Review Date 21-Nov-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Component 1: Supporting Service Delivery 14.00 Component 2: Institutional Streghtening and Capacity Building 16.00 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Satisfactory Moderately Satisfactory Satisfactory Public Disclosure Copy Overall Implementation Progress (IP) Overall Risk Rating NA Implementation Status Overview Component One: First, Community-Based Nutrition (CBN) was rolled out in 58 new woredas, bringing the total to 238 across the four main regions of the country (Tigray, Oromia, SNNPR, Amhara). Second, as of June 2011, a total of 11,900 Health Extension Workers (HEWs) and 118,500 Voluntary Community Health Workers (VCHWs) had received CBN training, an increase of 32 percent for both, respectively, since March 2011 (last ISR). Third, the most recent analysis of routine monthly Growth Monitoring and Promotion (GMP) data shows that coverage has increased from 52% to 60%, i.e., 1.08 million out of an estimated 1.8 million under-2 children in CBN woredas are participating, with 65% of VCHWs regularly submitting routine CBN reports to their respective HEWs. Fourth, the Canadian International Development Agency (CIDA) committed funds to roll out CBN in an additional 100 woredas in Oromia, SNNPR and Amhara; 40 in 2011 and the remaining 60 in 2012. Fifth, the final outstanding legal covenant on Mandatory Universal Salt Iodization (USI) came into force on April 13, 2011. Page 1 of 5 The World Bank Report No: ISR4410 Component Two: The Government is continuing to build the health sectorâ➂�➂ s capacity in nutrition. For the short-term, first, the National Nutrition Coordinator is now in place and the 4 Regional Nutrition Coordinators hired in March 2011 are actively supporting the project National Nutrition Program (NNP) implementation, including financial management and supportive supervisionspecifically CBN supervision and on-the-job training, as well as financial management and reporting at the woreda level. Second, the Ethiopian Health and Public Disclosure Copy Nutrition Research Institute (EHNRI) hired a Database Specialist to develop and manage a comprehensive national level nutrition database. Third, 3 experts, 2 from the Woreda Health Office and 1 from Food Security (Agriculture) Early Warning Office, were trained in data quality and utilization in 128 CBN woredas with a further 100 woredas currently receiving training. The Government has also taken two major steps to improve long-term capacity development. First, 30 out of a planned 50 health sector staff are pursuing a two- year sandwich Masters course in Applied Community Nutrition at Gondar University, Ethiopia. Second, the Federal Ministry of Health (FMOH) developed a diploma equivalent training package in the Health Extension Program (HEP) Packages, one of which is nutrition, in order to advance HEW skills and career opportunities. Progress has also been made on several studies that will inform further expansion of the NNP. First, the FMOH has finalized an assessment on the feasibility of food fortification, and in support of this initiative, EHNRI has completed the fieldwork of the first national food consumption survey with findings available by December 2011. Second, the EHNRI advertised the first 5 (out of a total of 10) Operational Research studies and is currently reviewing Expressions of Interests (EOIs) received. These contracts will be awarded in October 2011. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of infants 0-5 months exclusively Text Value 49.0% 5% above baseline (baseline breast fed (source DHS survey, project to be updated based on baseline and endline surveys; baseline from independent survey) 2005 DHS) Date 01-Sep-2006 30-Jun-2011 07-Jan-2014 Comments Results Framework will be There are no routine data Will be updated to 56% revised after MTR to use the available to monitor this following MTR agreement on National Nutrition Survey as indicator. We are relying on 3 changed data source. baseline: (51%, 2009), so surveys to monitor progress: progress can be assessed a) 2010 DHS, results using data from the scheduled expected in December 2011; endline NNP survey in 2014. b) midline results of the CBN survey, results expected by Public Disclosure Copy December 2011 c) National Food Consumption Survey, results expected in December 2011 Page 2 of 5 The World Bank Report No: ISR4410 Percentage of households using adequately Text Value 4.2% 60% iodized salt (source DHS survey, micronutrient surveys; baseline from EHNRI Date 01-Sep-2006 30-Jun-2011 07-Jan-2014 micronutrientsurvey of 2005) Comments DHS 2005; Baseline will be Administrative reports indicate Public Disclosure Copy updated to 5 that currently 20% of salt % using NNP 2009 survey produced is iodized at source. data following the MTR USI coverage figure will be updated in December 2011 based on DHS 2010 and National Food Consumption Survey, 2011. Percentage of pregnant women receiving iron Text Value 10% 15% above baseline (baseline and folate supplementation (source: DHS to be updated based on survey, project baseline and endline surveys; baseline survey) baseline from 2005 DHS) Date 01-Sep-2006 30-Jun-2011 07-Jan-2014 Comments Results Framework will be There are no routine service Will be updated to 32% revised after MTR to use the data available to monitor this following MTR agreement on National Nutrition Survey as indicator. We will monitor changed data source. baseline: (51%, 2009), so progress using CBN progress can be assessed evaluation survey and 2010 using data from the scheduled DHS (both results expected in endline NNP survey in 2014. December 2011). People with access to a basic package of Number Value 51130800.00 69360000.00 83746500.00 health, nutrition, or population services Date 29-Apr-2008 30-Jun-2011 07-Jan-2014 Comments Source: FMOH Figures estimated given that 87% of the total population is covered by basic health services. Source: FMOH Children receiving a dose of vitamin A Number Value 20914573.00 23143268.00 25077388.00 Date 29-Apr-2008 30-Jun-2011 07-Jan-2014 Comments UNICEF EOS 2008 data UNICEF EOS 2010 data Public Disclosure Copy Intermediate Results Indicators Page 3 of 5 The World Bank Report No: ISR4410 Indicator Name Core Unit of Measure Baseline Current End Target Health Extension Workers trained on revised Text Value 0% Achieved 80% curriculum: percentage out of a target of Date 29-Apr-2008 30-Jun-2011 07-Jan-2014 Public Disclosure Copy 30,000 to be achieved by project completion (source: HMIS, Annual NNP Reports; baseline Comments 31,831 HEWs received 2007) training on a basic health package (Source: Policy and Planing Directorate, Ministry of Health) Universal Salt Iodization policy adopted and Text Value Not yet achieved Achieved Achieved put in force, supporting Proclamation 200/2000 (Legislative Reports, Annual NNP Program Date 29-Apr-2008 30-Jun-2011 07-Jan-2014 Reports, project evaluations; baseline 2007) Comments The universal salt iodization policy legislated on February 18, 2011, came into force on April 13, 2011 Percentage of iodization machines functioning Text Value 3.3% (2 machines) 20% (12 machines) 100% (60 machines) out of 60 planned (NNP monitoring; baseline 2007) Date 29-Apr-2008 30-Jun-2011 07-Jan-2014 Comments Prototype of salt iodization machines manufactured locally to address extreme weather in Afar. Establishment of inter-sectoral National Text Value Not yet achieved Achieved Achieved Nutrition Coordination Body (source: Terms of Reference for body, Annual NNP Program Date 29-Apr-2008 22-Jun-2009 07-Jan-2014 Reports, project evaluations; baseline 2007) Comments Coordination will be further strengthened by appointing a national nutrition coordinator. Data on Financial Performance (as of 23-Aug-2011) Public Disclosure Copy Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P106228 IDA-H3760 Effective 29-Apr-2008 13-Jun-2008 10-Sep-2008 07-Jan-2014 P106228 TF-93946 Effective 16-Jun-2009 14-Aug-2009 14-Aug-2009 14-Aug-2013 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P106228 IDA-H3760 Effective USD 30.00 30.00 0.00 9.13 20.93 30.00 P106228 TF-93946 Effective USD 1.81 1.81 0.00 0.23 1.58 13.00 Page 4 of 5 The World Bank Report No: ISR4410 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation n/a Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Public Disclosure Copy Page 5 of 5