The World Bank Strengthening Primary Health Care for Results (P152736)

Transcription

1 Public Disclosure Authorized AFRICA Tanzania Health, Nutrition & Population Global Practice IBRD/IDA Program-for-Results FY 2015 Seq No: 5 ARCHIVED on 28-Dec-2017 ISR29780 Implementing Agencies: MINISTRY OF FINANCE, The President's Office for Regional Adminstration and Local Government, Ministry of Health and Social Welfare Public Disclosure Authorized Program Development Objectives Program Development Objective (from Program-for-Results Appraisal Document) The Program Development Objective is to improve the quality of primary health care (PHC) services nationwide with a focus on maternal, neonatal and child health (MNCH) services. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Public Disclosure Authorized Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions The Strengthening Primary Healthcare for Results (PHCforR) Program is in its second year of implementation and is making progress towards achieving its Program Development Objective (PDO). In the second year three of the five PDO indicators achieved the end target. There has been good progress on disbursement linked indicator (DLI) 1 (foundational activities), DLI 2 (program annual results in institutional strengthening) and DLI 7 (annual capacity building activities) where most of the sub-indicators were achieved. For DLI 4 (LGA scorecard for service coverage, quality, staffing, and governance), on average 66% of the Year 2 targets was achieved. In-depth analysis of DLI 3 (result-based financing program indicators) and DLI 4 to understand opportunities to accelerate the improvement will be carried out through the upcoming mid-term review tentatively planned for February, Public Disclosure Authorized Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P IDA Effective USD % P TF-A0261 Effective USD % P TF-A0270 Effective USD % Page 1 of 11

2 PHDLIPDOTBL P TF-A1567 Effective USD % Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P IDA Effective 28-May Aug Nov Jun P TF-A0261 Effective 28-May May Jul Jun P TF-A0270 Effective 28-May May Jul Jun P TF-A1567 Effective 23-May May Jul Jun 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 -- Moderate Moderate Fiduciary -- Moderate Moderate Environment and Social -- Low Moderate Stakeholders -- Low Low Other Overall -- Moderate Moderate Disbursement Linked Indicators (DLI) DLI 1: Recipient has completed foundational activities (Yes/No) Value N DLI 1 RESULTS 4 Completed/Achieved (DLR 1.1, 1.2; 1.4; 1.5). 2 Partially completed/partially Achieved (DLR 1.3, 1.6) - Financial Management Guidelines for Public Health Facilities have been developed and dissemination is not yet completed. Also, there was no updates on the indicator (1.6): Eight selected health centers in the five BRN RMNCH regions meeting CEmONC standards; and at least 70 percent of health centers in the five BRN RMNCH regions meeting BEmONC standards. Page 2 of 11

3 PHDLIPDOTBL PHDLIPDOTBL PHDLIPDOTBL DLI 2: Recipient has achieved all of the Program annual results in institutional strengthening at all levels (Yes/No) Value N DLI 2 RESULTS 4 Completed/Achieved (DLR 2.1; 2.2; 2.3, 2.4). 1 Not completed/not achieved (DLR 2.5). DETAILED ASSESSMENT: 2.1. Percentage of health in total government budget: ACHIEVED. Target: 9.65%; Actual: 12.6% 2.2. Percentage of council whose annual comprehensive Council Health Plan (CCHP) passes the first round of assessment: ACHIEVED. Target: 60%; Actual: 78% Action Plans of Audits of PMORALG and MOH received within 2 months of the official release of the controller and Auditor General (CAG) report: ACHIEVED, based on the latest verification report in October Percentage of PHC facilities with bank accounts opened according to guidelines from Ministry of Finance and Planning (MOFP)/CAG: ACHIEVED. Target: 40%; Actual: 95% Percentage of annual employment permits for PHC staff given to the 9 critical regions: NOT ACHIEVED. This target is not measured because of hiring freeze by the government Percentage of completion of Star Rating Assessment" of PHC facilities: COMPLETED. Target: 100%; Actual: 100%. DLI 3: PHC facilities have improved maternal, neonatal and child health services delivery and quality as per verified results and received payments on that basis each quarter (Number) Value ,526 facilities in eight regions (Mwanza, Shinyanga, Pwani, Kagera, Geita, Kagera, Tabora and Simiyu) out of 9 planned regions are now implementing RBF. Verification of DLI3 results was completed in November The analysis of the report and verified data are underway. DLI 4: LGAs have improved annual maternal, neonatal and child health services delivery and quality as measured by the LGA Balance Score Card. (Percentage) Value Page 3 of 11

4 PHDLIPDOTBL PHDLIPDOTBL DLI 4 RESULTS 8 Completed/Achieved (DLR 4.1; 4.2; 4.3; 4.4; 4.6; 4.9; 4.10; 4.11). 3 Partially completed/partially achieved (DLR 4.5; 4.8; 4.12). 1 Not Achieved (DLR 4.7). DETAILED ASSESSMENT: 4.1. Percentage of pregnant women attending four or more antenatal care visits (ANC4): ACHIEVED: Target: 42%; Actual: 42% Proportion of mothers who received 2 doses of intermittent preventive treatment (IPT2) for malaria during last pregnancy: ACHIEVED. Target: 61%; Actual: 60% Percentage of institutional deliveries: ACHIEVED. Target: 65%; Actual: 65% Percentage of women of reproductive age (15-49 years) using modern family planning methods: ACHIEVED: Target: 36%; Actual: 41% Percentage of pregnant women who receive adequate quantity of iron and folate tablets during their current ANC visit: PARTIALLY ACHIEVED: Target: 70%; Actual: 65% Proportion of children months receiving at least one dose of Vitamin A supplementation during the past year: ACHIEVED. Target: 74%; Actual: 100% Percent of PHC facilities with 3 stars rating or higher: NOT ACHIEVED. Target: 15%; Actual: 2% Number and percentage of Public primary health facility with at least one skilled staff: NOT ACHIEVED. Target: 92%; Actual: 81% Percentage of PHC facilities with continuous availability of 10 tracer medicines (medicines, vaccines, medical devices) in the past year: ACHIEVED. Target: 50%; Actual: 60% Percentage of LGAs with functional Council Health Service Boards (meeting quarterly): ACHIEVED. Target: 87%; Actual: 90% Percentage of completeness of quarterly DHIS 2 entry by LGA (MTUHA phase one forms by Day 30 after the end of each quarter): ACHIEVED. Target: 90%; Actual: 96.9% Percentage of LGAs with unqualified opinion in the external audit report. PARTIALLY ACHIEVED. Target: 84%; Actual: 81%. DLI 5: Regions have improved annual performance in supporting PHC services as measured by Regional Balance Score Card. (Percentage) Value DLI 5 RESULTS 1 Not completed/not achieved (DLR 5.1). 1 Completed/Achieved (DLR 5.2). DETAILED ASSESSMENT: 5.1 RHMTs required biannual data quality audits (DQA) for LGAs that meets national DQA standards. NOT ACHIEVED. Target: 60%; Actual: 19.2% RHMT's Required annual supportive supervision visits for LGAs that meets national supervision standards. ACHIEVED. Target: 60%; Actual: 85%. DLI 6: MOHSW and PMO-RALG have improved annual PHC service performance as measured by National Balance Scorecard (Percentage) Page 4 of 11

5 PHDLIPDOTBL Value DLI 6 RESULTS 2 Achieved/Completed (DLR 6.2; 6.3). 2 Not achieved/completed (DLR 6.1; 6.4). DETAILED ASSESSMENT: 6.1. Average of LGA performance score: NOT ACHIEVED. Target: 80%; Actual: 44.3% Average of Regional Performance Scores: ACHIEVED. Target: 50%; Actual: 51.6% Percentage of unsupported expenditure in MOH/PORALG in their annual audit. ACHIEVED. Target: 0%; Actual: 0.1% Percentage of LGA's receiving CHF matching funds: NOT ACHIEVED. Target: 57%; Actual: 29.3%. DLI 7: Completion of annual capacity building activities at all levels as per the agreed annual plans. (Yes/No) Value N -- Y The Capacity Building Plan for FY16/17 has been submitted for the Bank's approval. Capacity building plan for FY17 has been implemented and activities completed. Plan for FY18 is under discussion. Results Results Area Intermediate Results Area Intermediate Results Area 1: Health financing, public financial management Intermediate Results Area 2: Performance Management Intermediate Results Area 3: Human Resource for Health (HRH) Intermediate Results Area 4: Supply chain management Intermediate Results Area 5: RMNCAH continuum Intermediate Results Area 6: M&E, supervision, and capacity building Project Development Objective Indicators Page 5 of 11

6 PHINDPDOTBL PHC facilities with 3- Star Ratings and Above (Percentage, Custom) Value Data source: Star rating assessment and re assessment report (MoH) PHINDPDOTBL Pregnant women attending 4 or more ante-natal care (ANC) visits (Percentage, Custom) Value PHINDPDOTBL ANC attendees receiving at least 2 doses of intermittent preventive treatment (IPT2) for malaria (Percentage, Custom) Value Data Source: DHIS 2 (MoH PHINDPDOTBL Institutional deliveries (Percentage, Custom) Page 6 of 11

7 Value PHINDPDOTBL Proportion of children months receiving at least one dose of Vitamin A during the previous year (Percentage, Custom) Value Overall Except for the PHR facilities with 3 star rating or higher and ANC4, the project already achieved its PDO indicators. Intermediate Results Indicators Share of health in total government budget (Percentage, Custom) Value Date 25-Aug Mar Nov Jun-2020 Data Source: (MoF) Page 7 of 11

8 Councils with unqualified opinion in the annual external audit report (Percentage, Custom) Value Date 25-Aug Sep Nov Jun-2020 Data Source: CAG report Completion of Star rating" assessment of PHC facilities as per the two-year cycle (Percentage, Custom) Value Data Source: Star Rating assessment and reassessment report (MoH) RBF facilities receiving timely RBF payment on the basis of verified results every quarter (Percentage, Custom) Value Payment delayed for Jan-Mar, and Apr-Jun, They were paid recently, and the MOH is working to pay the Jul-Sep payment on-time, and verification exercise has been completed. Data Source: IAG report LGAs with functional Council Health Service Boards (Percentage, Custom) Page 8 of 11

9 Value Data Source: Boards and Facility committees implementation report Annual employment permits for PHC given to the 9 critical regions (Percentage, Custom) Value Date 25-Aug Sep Nov Jun-2020 From the first half of 2015/16 financial year until June 2017, the Government halted issuing of employment permits. The Government started issuing employment permits in June Health facilities with continuous availability of 10 tracer medicines in the past year (Percentage, Custom) Value Health facilities with CEmOC (Number, Custom) Value Date 25-Aug Sep Nov Jun-2020 Page 9 of 11

10 The MOH promised to carry out a survey to collect data by December, Completeness of quarterly HMIS data entered in DHIS by LGA (by the end of month after quarter ends) (Percentage, Custom) Value RHMT s required biannual data quality audits (DQA) for LGAs that meets national DQA standards (Percentage, Custom) Value Completion of annual capacity building activities compared to agreed annual plans (Percentage, Custom) Value Data Source: Annual implementation report for MoH Page 10 of 11

11 Dispensaries with skilled HRH (Percentage, Custom) Value RHMT's required annual supportive supervision visits for LGAs that meets national supervision standards (Percentage, Custom) Value Overall Page 11 of 11