Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) AFRICA | Uganda | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 5 | ARCHIVED on 28-Dec-2018 | ISR35221 | Implementing Agencies: Ministry of Finance, Planning and Economic Development, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 04-Aug-2016 Effectiveness Date: 26-May-2017 Planned Mid Term Review Date: 14-Oct-2019 Actual Mid-Term Review Date: -- Original Closing Date: 30-Jun-2021 Revised Closing Date: 30-Jun-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objectives (PDOs) are to: (a) improve utilization of essential health services with a focus on reproductive, maternal, newborn, child and adolescent health services in target districts; and (b) scale up birth and death registration services Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Results-Based Financing for Primary Health Care Services:(Cost $85.50 M) Component 2: Strengthen Health Systems to Deliver RMNCAH Services:(Cost $62.00 M) Component Three: Strengthen Capacity to Scale-up Delivery of Births and Deaths Registration Services:(Cost $10.00 M) Component Four: Enhance Institutional Capacity to Manage Project Supported Activities:(Cost $7.50 M) Contingent Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Unsatisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The project’s progress after two years of implementation remains slow, with disbursements at 10 percent (after additional financing of US$25 million). During the last implementation support mission in September, 2018, the MoH was urged to: (i) accelerate implementation of key activities 12/28/2018 Page 1 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) including the rollout of RBF; (ii) urgently address all barrier to procurements and payments; (iii) complete all steps necessary to initiate the civil works; and (iv) recruit all remaining key personnel, including--importantly-- the Internal Auditor. These actions are critical as the PIU prepares for the Mid-Term Review of the project in October 2019. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Sustainability High High High Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Substantial Stakeholders Substantial Substantial Substantial Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improve utilization of essential health services with a focus on reproductive, maternal, newborn, ch IN00653919 ►Children under one year immunized with 3rd dose of pneumococcal conjugate vaccine (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 79.00 -- 92.60 90.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 IN00653920 ►Pregnant women who received IPT2 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/28/2018 Page 2 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Value 53.00 -- 63.20 80.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 IN00653928 ►Couple Years of Protection (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3,308,142.00 -- 2,540,251.00 3,500,000.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 IN00653929 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 2,550,000.00 3,200,000.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 IN00653930 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 0.00 IN00653936 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 1,535,000.00 1,800,000.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 IN00653937 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 0.00 Date 30-Jun-2015 -- 14-Dec-2018 30-Jun-2021 IN00653938 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 1,020,000.00 1,400,000.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 Scale up birth and death registration services IN00653922 ►Children under five years with birth registration (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/28/2018 Page 3 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Value 54,127.00 -- 23,667.00 500,000.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 IN00653923 ►Total number of deaths registered (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3,340.00 -- 3,411.00 50,000.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 Intermediate Results Indicators by Components Component 1: Results-Based Financing for Primary Health Care Services IN00653925 ►Pregnant women receiving antenatal care during a visit to a health provider (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,500,000.00 -- 4,791,351.00 1,650,000.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 IN00653946 ►RBF health facilities with functional HUMCs with citizen representation (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 -- 0.00 100.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 Since the RBF component of the Project has not started, there is no current data for this indicator. Comments: IN00653947 ►HC IVs offering caesarian section (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 -- 71.70 75.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 IN00653948 ►Districts with functional ambulance and referral system (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 25.00 75.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 Component 2: Strengthen Health Systems to Deliver RMNCAH Services 12/28/2018 Page 4 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) IN00653949 ►Health facilities constructed, renovated, and/or equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 150.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 Civil works has not started so there is no current data. Comments: IN00653950 ►Health personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 766.00 400.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 IN00653951 ►Health facilities with placed orders that are fully filled by National Medical Stores (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.00 -- 77.00 80.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 IN00653952 ►Approved posts in public facilities filled by qualified health workers (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.00 -- 74.00 75.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 IN00653910 ►Health facilities attaining at least 2 star rating under the QA Program (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 Data on this is also mot available since activities on the QA program are delayed. Comments: IN00653956 ►Health facilities without stock-outs of any of the six tracer drugs in the previous three months (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 64.00 -- 85.00 80.00 Date 30-Jun-2015 -- 06-Dec-2018 30-Jun-2021 IN00656384 ►Clients expressing satisfaction with health (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/28/2018 Page 5 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Value 70.00 -- 0.00 80.00 Date 30-Jun-2015 -- 14-Dec-2018 30-Jun-2021 The actual data for this indicator is blank. The Client Satisfaction Index was not assessed this year however, there was an assessment of the community perspectives on an array of healthcare related services undertaken in the Uganda National Household Survey 2016/17 by UBOS. According to the UNHS 2016/17, the major concerns of the communities in accessing health services at the public health Comments: facilities were; unavailability of medicines/supplies (23%), long waiting time (13%), long distance (12%), limited range of services (14%) and understaffing (10%). Whereas, in private facilities, it was found that the services being expensive (39%) ranked top followed by limited range of services (23%) and long istance (9%). Component Three: Strengthen Capacity to Scale-up Delivery of Births and Deaths Registration Services IN00653957 ►Reported maternal deaths that are audited (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 33.00 -- 49.50 65.00 Date 06-Dec-2018 -- 06-Dec-2018 30-Jun-2021 Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P155186 IDA-58970 Effective USD 110.00 110.00 0.00 11.83 96.98 11% P155186 TF-A2977 Effective USD 30.00 30.00 0.00 5.00 25.00 17% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P155186 IDA-58970 Effective 04-Aug-2016 19-Jan-2017 26-May-2017 30-Jun-2021 30-Jun-2021 P155186 TF-A2977 Effective 19-Jan-2017 19-Jan-2017 26-May-2017 30-Jun-2021 30-Jun-2021 Cumulative Disbursements 12/28/2018 Page 6 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Restructuring History There has been no restructuring to date. Related Project(s) P163691-Additional Financing Uganda Reproductive Maternal and Child Health Services Improvement Project 12/28/2018 Page 7 of 7