Public Disclosure Copy The World Bank Implementation Status & Results Report Community Health Collaborative JSDF (P125657) Community Health Collaborative JSDF (P125657) MIDDLE EAST AND NORTH AFRICA | Tunisia | Health, Nutrition & Population Global Practice | Recipient Executed Activities | Technical Assistance Loan | FY 2011 | Seq No: 7 | ARCHIVED on 11-Jan-2016 | ISR21233 | Implementing Agencies: Key Dates Key Project Dates Bank Approval Date:24-Mar-2011 Effectiveness Date:18-Jul-2012 Original Closing Date:22-Nov-2015 Revised Closing Date:30-Jun-2016 Project Development Objectives Project Development Objective (from Project Appraisal Document) The main objective of this Grant is to improve the quality and responsiveness of health service delivery for reproductive health through community involvement and empowerment in planning and delivering health services in under-served areas of the Republic of Tunisia's peri-urban and rural governorates in the southeast (Tataouine), central west (Kasserine), and northwest (Jendouba). Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Satisfactory Implementation Status and Key Decisions Project implementation has accelerated with commensurate increases in disbursements. Disbursement rate has increased from 27 percent in February 2014 to 78 percent as of October 2015. The contract between Direction des soins de santé de base (DSSB), Ministry of Health, and a national NGO (Association tunisienne de la santé de la reproduction -- ATSR) is being implemented satisfactorily. Project activities completed jointly by DSSB and ATSR include the following: i) organization of 18 regional training sessions about interpersonal communication for behavior change, breastfeeding and growth monitoring, 1/11/2016 Page 1 of 5 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Community Health Collaborative JSDF (P125657) perinatal care and immunization, gynecological cancers and prenuptial care, HIV and STIs, birth control and reproductive health. For each theme, there were three sessions (one in each region); about 50 people attended each session; direct beneficiaries included members of the community/citizens, as well as representatives of ATSR and health professionals. In addition, community leaders and representatives of ATSR subsequently reached out to the communities to share their knowledge and raise awareness about reproductive health within the communities; ii) establishment of community committees (there are twelve committees; each committee includes around 20 participants/community leaders), preparation of community scorecards and preparation and implementation of participatory local action plans to improve health services, including acquisition of equipment for the local health facilities included in the communities’ priorities (e.g. medical equipment, information, education and communication tools, etc.); (iii) preparation and implementation of participatory monitoring and evaluation mechanisms, including (a) monitoring and evaluation of the participatory local action plans by the community committees, and (b) impact evaluation surveys (the baseline survey was conducted in 2013; the final survey, which will be conducted by April 2016, will measure the impact on result indicators, e.g. number of health care visits, satisfaction rate, waiting time, etc.). On November 10, 2015, the closing date was extended by 7 months from November 22, 2015 to June 30, 2016 in order to provide sufficient time to satisfactorily complete all ongoing activities, including the completion of the impact evaluation survey, and the procurement and delivery of the remaining batches of medical goods to target health facilities. Risks Overall Risk Rating Risk Category Rating at Approval Previous Rating Current Rating Overall  Low  --  Low Results Project Development Objective Indicators 1/11/2016 Page 2 of 5 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Community Health Collaborative JSDF (P125657) PHINDPDOTBL Births attended by skilled personnel in rural regions (%) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.00 99.00 99.00 85.00 Date 18-Jul-2012 31-Dec-2013 31-Dec-2013 30-Jun-2016 PHINDPDOTBL Proportion of women waiting 4 hours or less for ambulatory care (general; obstetrics and gynecology) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 30.00 96.00 96.00 80.00 Date 18-Jul-2012 31-Dec-2013 31-Dec-2013 30-Jun-2016 PHINDPDOTBL Proportion of citizens satisfied or very satisfied with maternal health services (% of women satisfied or verysatisfied) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 55.00 52.00 52.00 70.00 Date 18-Jul-2012 31-Dec-2013 01-Dec-2013 30-Jun-2016 Overall Comments The baseline values for the above indicators were estimates. The so-called actual values are results of the specific impact evaluation baseline survey that was conducted end of 2013. The target values for Indicator 1 (Births attended by skilled personnel in rural regions (%)) and Indicator 2 (Proportion of women waiting 4 hours or less for ambulatory care (general; obstetrics and gynecology)) are exceeded because of inaccurate initial estimates. The team continues to monitor these indicators as it is important that their values remain constantly high. In addition, the team will monitor the following indicators, which are expected to improve: - Proportion of children receiving post-natal care. Baseline value (specific impact evaluation baseline survey): 27 percent. Target: 60 percent (which is the national target). - Proportion of women waiting 2 hours or less for ambulatory care (general; obstetrics and gynecology). Baseline value (specific impact evaluation baseline survey): 60 percent. Target: 100 percent. A specific survey will be conducted by the closing date to evaluate the results of the project. Intermediate Results Indicators 1/11/2016 Page 3 of 5 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Community Health Collaborative JSDF (P125657) PHINDIRITBL Proportion of women receiving antenatal care (4 visits) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 40.00 -- 47.00 70.00 Date 18-Jul-2012 -- 31-Dec-2013 01-Nov-2013 Overall Comments The baseline value for the above indicator was an estimate. The so-called actual value is a result of the specific impact evaluation baseline survey that was conducted end of 2013. A specific survey will be conducted by the closing date to evaluate the results of the project. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P125657 TF-99374 Effective USD 0.88 0.88 0.00 0.68 0.20 78% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P125657 TF-99374 Effective 21-Nov-2011 22-Nov-2011 18-Jul-2012 22-Nov-2015 30-Jun-2016 Cumulative Disbursements 1/11/2016 Page 4 of 5 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Community Health Collaborative JSDF (P125657) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 1/11/2016 Page 5 of 5 Public Disclosure Copy