Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) DJ Improving Health Sector Performance (P131194) MIDDLE EAST AND NORTH AFRICA | Djibouti | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2013 | Seq No: 10 | ARCHIVED on 06-Mar-2018 | ISR31397 | Implementing Agencies: Republic of Djibouti, Ministry of Health Key Dates Key Project Dates Bank Approval Date:02-Apr-2013 Effectiveness Date:11-Jul-2013 Planned Mid Term Review Date:15-Mar-2016 Actual Mid-Term Review Date:23-May-2016 Original Closing Date:31-Dec-2018 Revised Closing Date:31-Dec-2018 Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is to improve the utilization of quality health care services for maternal and child health andcommunicable disease control programs (HIV/AIDS, tuberculosis and malaria). Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) The project development objective is to improve the utilization of quality health care services for maternal and child health and communicable disease control programs (HIV/AIDS and tuberculosis). Components Name Improving health services delivery performance:(Cost $4.00 M) Strengthening health system management:(Cost $1.00 M) Strengthening program management and monitoring and evaluation capacity:(Cost $2.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Satisfactory 3/6/2018 Public Disclosure Copy Page 1 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) Overall Risk Rating  Substantial  Substantial Implementation Status and Key Decisions A mission took place from January 21 to February 1, 2018. The project is on track; indicators show progress in reaching the target population and with the planned restructuring the funds are expected to be fully disbursed by the closing date of December 31, 2018. Project restructuring is underway to revise the results framework, reallocate funds between different components, and introduce a contingent emergency response component, which enables quick disbursement of remaining funds if a health-related emergency/crisis occurs. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  Moderate  Moderate Macroeconomic  --  Moderate  Moderate Sector Strategies and Policies  --  Low  Low Technical Design of Project or Program  --  Moderate  Moderate Institutional Capacity for Implementation and Sustainability  --  Substantial  Substantial Fiduciary  --  Moderate  Moderate Environment and Social  --  Moderate  Moderate Stakeholders  --  Moderate  Moderate Other  --  --  -- Overall  --  Substantial  Substantial Results Project Development Objective Indicators PHINDPDOTBL  Number of women receiving prenatal visits 2-4 (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 6,100.00 48,781.00 61,180.00 77,100.00 Date 01-Jun-2014 07-Jun-2017 31-Dec-2017 31-Dec-2018 3/6/2018 Public Disclosure Copy Page 2 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) PHINDPDOTBL  Average facility quality (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 29.00 40.60 46.10 60.00 Date 01-Dec-2012 15-Jun-2017 31-Dec-2017 31-Dec-2018 PHINDPDOTBL  Percentage of children fully immunized before their first birthday (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.00 67.98 45.51 51.50 Date 01-Dec-2012 02-Jan-2017 31-Dec-2017 31-Dec-2018 PHINDPDOTBL  Number of HIV positive pregnant women receiving treatment according to protocol (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 63.00 339.00 317.00 1,175.00 Date 01-Nov-2014 02-Jan-2017 31-Dec-2017 31-Dec-2018 Overall Comments The percentage of children fully immunized went down in 2017 due to the aging cold chain equipment and resulting unavailability of vaccines. In September 2017, however, GAVI provided new equipment, thus this indicator is expected to show improvement in 2018. The progress data for the number of HIV positive pregnant women receiving treatment according to protocol was wrongly captured in the previous ISR; it should have been 276 as of the end of 2016. Intermediate Results Indicators 3/6/2018 Public Disclosure Copy Page 3 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) PHINDIRITBL  Number of WCBA visiting the public system to obtain modern family planning (oral contraceptives and injections) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7,304.00 61,425.00 73,860.00 105,000.00 Date 01-Nov-2014 07-Jun-2017 31-Dec-2017 31-Dec-2018 PHINDIRITBL  Pregnant/lactating women, adolescent girls and/or children under age five-reached by basic nutrition services (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7,117.00 43,674.00 126,042.00 150,000.00 Date 01-Nov-2014 07-Jun-2017 31-Dec-2017 31-Dec-2018 PHINDIRITBL  Pregnant/lactating women, adolescent girls and/or children under age five- reached by basic nutrition services – Others (specify) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 7,117.00 43,674.00 126,042.00 150,000.00 Date 01-Nov-2014 07-Jun-2017 31-Dec-2017 31-Dec-2018 PHINDIRITBL  Number of women giving birth in a contracted facility assisted by qualified personnel (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,026.00 2,014.00 19,206.00 25,525.00 Date 01-Jun-2014 14-Apr-2015 31-Dec-2017 31-Dec-2018 3/6/2018 Public Disclosure Copy Page 4 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) PHINDIRITBL  Percentage of pregnant women receiving at least two doses of tetanus toxoid (TT2) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 30.20 27.20 45.00 Date 01-Dec-2012 15-Jun-2017 31-Dec-2017 31-Dec-2018 PHINDIRITBL  Number of curative care visits per person per year in the public system (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.15 0.33 0.46 0.52 Date 01-Nov-2014 15-Jun-2017 31-Dec-2017 31-Dec-2018 PHINDIRITBL  People receiving tuberculosis treatment in accordance with the WHO-recommended “Directly Observed Treatment Strategy” (DOTS) (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 300.00 1,799.00 2,849.00 2,100.00 Date 01-Dec-2012 07-Jun-2017 31-Dec-2017 31-Dec-2018 PHINDIRITBL  Direct project beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,123,092.00 1,543,826.00 825,000.00 Date 01-Dec-2012 15-Jun-2017 31-Dec-2017 31-Dec-2018 3/6/2018 Public Disclosure Copy Page 5 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) PHINDIRITBL  Female beneficiaries (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 31.00 60.00 65.00 Overall Comments The indicator "pregnant/lactating women, adolescent girls and/or children under age five reached by basic nutrition services" used to capture only the children who were treated for malnutrition. The current progress data includes the children who received other nutrition services, including prevention and screening for malnutrition. The percentage of pregnant women receiving at least two doses of tetanus toxoid (TT2) went down due to the deteriorating cold chain equipment in 2017. With the provision of new equipment by GAVI, this percentage is expected to go up in 2018. The indicator "direct project beneficiaries" will be revised as part of restructuring. The current method counts the number of consultations, rather than the number of people. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P131194 IDA-52160 Effective USD 7.00 7.00 0.00 5.84 0.74 89% P131194 TF-19258 Effective USD 7.00 7.00 0.00 3.04 3.96 43% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P131194 IDA-52160 Effective 02-Apr-2013 21-Apr-2013 11-Jul-2013 31-Dec-2018 31-Dec-2018 P131194 TF-19258 Effective 13-May-2015 13-May-2015 27-Jul-2015 31-Dec-2018 31-Dec-2018 Cumulative Disbursements 3/6/2018 Public Disclosure Copy Page 6 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) Restructuring History Level 1 Approved on 23-Apr-2015 Related Project(s) P152705-DJ HRITF Health AF 3/6/2018 Public Disclosure Copy Page 7 of 7