The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Kyrgyz Second Health and Social Protection Project (P126278) EUROPE AND CENTRAL ASIA | Kyrgyz Republic | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2013 | Seq No: 13 | ARCHIVED on 13-Dec-2018 | ISR34967 | Implementing Agencies: Kyrgyz Republic, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 03-May-2013 Effectiveness Date: 11-Jul-2014 Planned Mid Term Review Date: 20-Jun-2016 Actual Mid-Term Review Date: 15-Jun-2016 Original Closing Date: 31-Dec-2018 Revised Closing Date: 31-Dec-2019 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed PDO is to: (i) improve health outcomes in four health priority areas in support of the “Den Sooluk” National Health Reform Program 2012-2016; and (ii) enable the Government's efforts to enhance effectiveness and targeting performance of social assistance and services 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 proposed new PDO is to contribute to improving delivery of quality maternal and child health care services within the “Den Sooluk” National Health Reform Program. Components Table Name Component 1 – Strengthening the delivery of quality MCH care services within eh "Den Sooluk" National Health Reform Program:(Cost $13.50 M) Component 2 – Strenghtening Health System within teh "Den Sooluk" National Health Reform Program:(Cost $3.00 M) Component 3: Contingency Emergency Response (no funds allocated) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions 12/13/2018 Page 1 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Progress toward achievement of PDO remains to be rated as Satisfactory. Out of five PDO indicators, three have shown to be achieved or over-achieved relative to the targets for the year 2018 for which data are reported. Specifically, the percentage of normal deliveries in rayon hospitals following clinical protocol has been reported as 92%, against the end target of 58% for 2018. For complicated deliveries, the data reports 66.5%, against an end target of 43% for 2018. Government expenditure on health is confirmed at 13% of total government expenditure based on approved budget for 2018. For two indicators (number of births attended by a skilled professional and proportion of children under 5 with diarrhea being treated with oral rehydration therapy) the data for 2018 will come from the health management information system and will be available in quarter 1 of 2019. Implementation progress remains as moderately satisfactory. On Health, there has been a significant deterioration of the MoH procurement capacity as the head of procurement department was rotated to the other medical structure (not related to procurement). New head of department according to the local law will be hired within 1 or 2 months. Currently there is only one acting senior procurement specialist in the department along with one procurement consultant. Two other positions are vacant. The leadership of the MOH has committed to fill the position of the Head by the end of December. Some positive developments have been registered under the Social Protection sub-component: the MLSD State Secretary has been designated as a project coordinator; the Ministry’s corporate MIS is in the process of getting a comprehensive upgrade; the MLSD’s has established a technical commission to supervise further development and implementation of the new corporate MIS. At the same time, challenges remain: To ensure sustainability of the technology investments undertaken under the project, the MIS maintenance cost must be explicitly provided in the Ministry’s annual budget. Implementation of the new Law on Social Benefits encountered serious challenges. Despite projected increase in the number of beneficiaries of social assistance in 2018, compared to 2017, the numbers remained stagnant. Correspondingly, the budget for the year 2018 has been underutilized and significant unused funds had to be returned to the state budget. The situation calls for urgent and comprehensive assessment of targeting and enrollment mechanisms, as had been previously agreed with other development partners. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Substantial Substantial Sector Strategies and Policies -- High High Technical Design of Project or Program -- High High Institutional Capacity for Implementation and Sustainability -- High High Fiduciary -- High High Environment and Social -- Low Low Stakeholders -- Substantial Substantial Other -- Substantial Substantial Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes To contribute to improving delivery of quality maternal and child health care services. IN00605711 ►Proportion of normal deliveries in district (rayon) hospitals that received services following clinical protocols (Percentage, Custom) 12/13/2018 Page 2 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Baseline Actual (Previous) Actual (Current) End Target Value 5.70 73.80 91.70 58.00 Date 01-Jul-2014 18-May-2018 19-Oct-2018 31-Dec-2018 IN00605712 ►Proportion of complicated deliveries in district (rayon) hospitals that received services following clinical protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.50 61.10 66.50 43.00 Date 01-Jul-2014 18-May-2018 19-Oct-2018 31-Dec-2018 IN00605719 ►Births (deliveries) attended by skilled health personnel (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 150,000.00 777,224.00 777,224.00 916,000.00 Date 31-Dec-2013 18-May-2018 18-May-2018 31-Dec-2018 IN00605713 ►Diarrhea treatment with oral rehydration therapy (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 77.00 82.10 82.10 80.00 Date 31-Dec-2013 18-May-2018 18-May-2018 31-Dec-2018 Data will be available in 2019. Comments: IN00605707 ►Government health expenditure as % of total government expenditure (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 13.70 13.00 13.00 13.00 Date 31-Dec-2013 18-May-2018 18-May-2018 31-Dec-2018 Intermediate Results Indicators by Components Component 1. Strengthening the delivery of quality MCH care services within "Den Sooluk" National IN00605714 ►Number of facilities adequately equipped to provide emergency obstetric and neonatal care (cumulative) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 31-Dec-2013 18-May-2018 18-May-2018 31-Dec-2019 12/13/2018 Page 3 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Number of oblast hospital maternity wards and city perinatal centers having the full set of basic equipment required to provide emergency obstetric care. Comments: Status update October 2018: contract is being signed for 3 out of 4 lots. Retendering for the remaining lot has not been completed. IN00605717 ►Number of pregnant women receiving any antenatal care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 148,000.00 766,019.00 766,019.00 909,000.00 Date 31-Dec-2013 18-May-2018 18-May-2018 31-Dec-2019 IN00605723 ►Number of providers trained in postnatal and postabortal IUD insertion and removal (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 76.00 355.00 200.00 Date 31-Dec-2013 18-May-2018 19-Oct-2018 31-Dec-2019 IN00605710 ►Children immunized (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 135,000.00 697,000.00 850,940.00 837,000.00 Date 31-Dec-2013 18-May-2018 19-Oct-2018 31-Dec-2019 IN00605725 Children immunized - under 12 months against DTP3 (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 135,000.00 699,732.00 847,573.00 837,000.00 Date 31-Dec-2012 18-May-2018 19-Oct-2018 31-Dec-2019 IN00605726 Children immunized - under 12 months against Polio (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 135,000.00 703,099.00 850,940.00 837,000.00 Date 31-Dec-2013 18-May-2018 19-Oct-2018 31-Dec-2019 IN00605715 ►Number of children treated with ORS for diarrhea or with antibiotic for pneumonia (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 53,000.00 134,145.00 134,145.00 177,000.00 Date 31-Dec-2013 18-May-2018 18-May-2018 31-Dec-2019 Component 2. Strenghtening Health System within the "Den Sooluk" National Health Reform Program IN00605716 12/13/2018 Page 4 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) ►Proportion of HIV infected pregnant women that received antiretroviral drugs to reduce risk of mother-to-child transmission (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 96.10 95.20 100.00 95.00 Date 31-Dec-2013 18-May-2018 19-Oct-2018 31-Dec-2019 IN00605718 ►Number of family doctors, feldshers, TB doctors and nurses trained on TB clinical protocols and guidelines (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5,835.00 6,039.00 3,300.00 Date 31-Dec-2013 18-May-2018 19-Oct-2018 31-Dec-2019 The reported figure is through Oct 2018. More training will take place during Oct -Dec 2018 and total value Comments: for 2018 will be reported in 2019. IN00605720 ►Number of family doctors, feldshers and nurses trained on CVD (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,479.00 3,194.00 4,500.00 Date 31-Dec-2013 18-May-2018 19-Oct-2018 31-Dec-2019 The reported figure is through Oct 2018. More training will take place during Oct -Dec 2018 and total value Comments: for 2018 will be reported in 2019. IN00605708 ►Percentage of negative deviations of the executed health budget from the initially approved budget and quarterly allocations and execution of the health budget (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 4.65 4.65 5.00 Date 31-Dec-2012 18-May-2018 18-May-2018 31-Dec-2019 IN00605709 ►Submission of IFRs satisfactory to IDA within due dates according to Financing Agreement (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Dec-2012 18-May-2018 19-Oct-2018 31-Dec-2019 IN00605721 ►Proportion of electronically registered families with children receiving social assistance (MBPF) who are electronically registered (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 31-Dec-2013 18-May-2017 19-Oct-2018 31-Dec-2019 IN00605722 ►Number of districts where the Social Registry Information System has been fully rolled out (Number, Custom) 12/13/2018 Page 5 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 50.00 54.00 54.00 Date 31-Dec-2013 18-May-2018 19-Oct-2018 31-Dec-2019 The last of the remote districts was connected on-line to the new MIS system, reaching the target of connecting all the districts in the country. Comments: the total number of districts is reduced from 57 to 54 due to recent administrative consolidation. IN00605724 ►Roadmap to reform disability service developed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Dec-2012 18-May-2018 19-Oct-2018 31-Dec-2019 IN00650859 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 1,617,892.00 1,816,000.00 Date 31-Dec-2013 -- 19-Oct-2018 31-Dec-2019 This indicator is the sum of two sub CRIs: (1) number of children immunized; and (2) number of births delivered by a skilled health personnel. The number of children immunized (children under 5) was not included in the original result framework. Other Corporate Result Indicators are not supported by the Comments: project. Value reported in October 2018 is for the year 2017. 2018 value will be available in quarter 1 of 2019. IN00650906 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 840,668.00 900,000.00 Date 31-Dec-2013 -- 19-Oct-2018 31-Dec-2019 IN00650908 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 777,224.00 916,000.00 Date 31-Dec-2013 -- 19-Oct-2018 31-Dec-2019 Overall Comments IR reported values are for 2017. Values for 2018 will be available in quarter 1 of 2019. 12/13/2018 Page 6 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P126278 IDA-52350 Effective USD 9.07 9.07 0.00 7.81 0.44 95% P126278 IDA-H8390 Effective USD 7.43 7.43 0.00 6.85 0.00 100% P126278 TF-15135 Effective USD 11.96 11.96 0.00 11.96 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P126278 IDA-52350 Effective 03-May-2013 16-Dec-2013 11-Jul-2014 31-Dec-2018 31-Dec-2019 P126278 IDA-H8390 Effective 03-May-2013 16-Dec-2013 11-Jul-2014 31-Dec-2018 31-Dec-2018 P126278 TF-15135 Effective 05-Feb-2014 28-May-2014 11-Jul-2014 30-Jun-2016 31-Dec-2018 Cumulative Disbursements 12/13/2018 Page 7 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Restructuring History Level 2 Approved on 16-Nov-2015 ,Level 1 Approved on 07-Mar-2017 ,Level 2 Approved on 07-Apr-2017 ,Level 2 Approved on 17-Sep-2018 Related Project(s) There are no related projects. 12/13/2018 Page 8 of 8