Implementation Status & Results India India: Reproductive & Child Health Second Phase (P075060)

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1 losure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized The World Bank Implementation Status & Results India India: Reproductive & Child Health Second Phase (P075060) Operation Name: India: Reproductive & Child Health Second Phase (P075060) Project Stage: Implementation Seq.No: 12 Status: ARCHIVED Archive : 09-Aug-2011 Country: India Approval FY: 2007 Product Line: IBRD/IDA Region: SOUTH ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of Health and Family Welfare Key s Board Approval Original Closing 30-Sep-2010 Planned Mid Term Review 15-Aug-2008 Last Archived ISR 09-Aug-2011 Effectiveness 10-Nov-2006 Revised Closing Actual Mid Term Review 05-Dec-2008 Project Development Objectives Project Development Objective (from Project Appraisal Document) To expand the use of essential reproductive and child health services of adequate quality with reduction of geographical disparities. Has the Project Development Objective been changed since Board Approval of the Project? Yes Component(s) Component Name No Component Cost Improvement in Essential RCH services Technical Assistance, Monitoring and Evaluation Polio Eradication Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview This project supports the Second Reproductive and Child Health (RCH) II program of the Government of India, also supported by other development partners. The program has made progress towards key outcomes in terms of increased access to deliveries by skilled birth attendants, children fully immunized, and increased access to family planning. However, concerns remain about the quality of care in delivery of RCH services and the near stagnant rates for the use of Oral Rehydration Solution (ORS) in management of diarrhea. The program as well as the Bank support to it ends on the 31st March, The Ministry of Health and Family Welfare (MOHFW) has concentrated on actions to improve access to quality RCH services, resulting in improved impact in the following areas: (i) Page 1 of 8

2 under the conditional cash transfer scheme of the Janani Suraksha Yojana (JSY) more than 11 million women delivered in institutions in ; (ii) field visits indicate that essential maternal health drugs are now available in the system; (iii) the quality of data in the web-based Health Management Information System (HMIS) and the Maternal Child Tracking System (MCTS) has shown steady improvement; (iv) the state Program Implementation Plans (PIPs) and annual budgets demonstrate a stronger focus on reaching vulnerable groups, with some variations in approach; (v) State/District Programme Management Units have been set up in all states, are involved in the day to day management of the program and have greatly enhanced the efficiency of implementation; (vi) there are systematic district planning processes in place in most states, with continuous progress in the quality and number of District Health Action Plans which have increased from 284 in , to 636/640 in 2011; (vii) the establishment of a system and culture of quarterly financial reporting has led to improvements in the timeliness of financial reporting by states; (viii) program management has been strengthened and the Bank team has provided supportive supervision in 264 high focus districts with poor health outcomes; (ix) Quality Assurance Committees (QACs) at state and district level have been strengthened to improve quality of RCH services; and (x) a scheme to support "zero cost" deliveries at facilities for pregnant women using a results based financing approach was designed and implemented. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Children receiving a dose of vitamin A Number Value Number of children under 1 yr of age receiving first dose of Vit A based on coverage from household survey (2005), birth rates and estimated population. This corresponds to a figure of Pregnant women receiving antenatal care during a visit to a health provider The no. of states (out of 34) having achieved the endline target (75%) has increased from 6 to 12 between DLHS 2 and 3. In the 8 weak states the number of states achieving endline (60%) has increased from 0 to 2. The figure according to the 2009 UNICEF survey is 61% Annual number of children under 1 yr of age receiving first dose of Vit A based on survey (DLHS ; CES 2009), birth rates and estimated population. This reflects a cumulative figure for the incremental number of children receiving a dose of Vit A to reach a target of 70% from the baseline which was at 31.1%. This requires an annualized growth rate of 39% to reach the target. Number Value Annual number of women receiving any antenatal care based on coverage from household survey and estimated population. This Annual number of women receiving any antenatal care during one year based on survey (DLHS ; CES 2009), birthrates (2008) Annual number of women receiving any antenatal care during one year based on survey (DLHS ; CES 2009), birthrates (2008) Page 2 of 8

3 corresponds to a figure of 21,112,897 in the base year. and estimated population. This reflects a cumulative figure for the incremental number of women receiving antenatal care above the baseline. Children immunized Number Value Number of children under 1 yr of age fully immunized annually based on coverage from household survey (2005) and estimated population and crude birth rate. This corresponds to a figure of 11,969,886 children immunized in the base year. At least 80% households with eligible children covered during national & sub national immunisation days in high risk districts Annual number of children fully immunized based on survey DLHS-3, , CES from 2009 and birth rates, and estimated population. In addition, 172 million children (0-5 yrs) immunized under national polio eradication program during every National Immunization Day (NID). This reflects a cumulative figure for the incremental number of children fully immunized above the baseline. and estimated population. This reflects a cumulative figure for the incremental number of women receiving antenatal care to reach a target of 80% from the baseline which was at 73.6%. This requires an annualized growth rate of 1.8% to reach the target. Annual number of children fully immunized based on survey DLHS-3, , CES from 2009 and birth rates, and estimated population. This reflects a cumulative figure for the incremental number of children to be fully immunized against a final coverage target of 75%. A linear increase has been assumed from the baseline which was at 45.9%. This requires an annualized growth rate of 8%. Text Value 0 Above 97.5% 80% From National Polio Surveillance Project (NPSP) No confirmed case of Polio has been reported from any data. The data for households State of the country after 13th are for the states of UP and January 2011 Bihar that house all high risk districts in the country. Also, the % children (0-2 yrs) found immunized during 2011 for UP and Bihar was also above 97.5 %. There has been no WPV polio case since January 13, Page 3 of 8

4 percentage of months children fully immunized Percentage of eligible couples using any modern contraceptive method Text Value 45% (28% for 8 weak states) 61% 75% (60% for 8 weak states) (47.5% for 8 weak states) The results of UNICEF Coverage Evaluation survey (CES-2009) indicate an overall improvement from baseline of 45% ( ) to 61% in out of 29 States (6 Union Territories excluded) have achieved the overall end line target of 75%. For the 8 weak States there is a combined improvement from the baseline of 28% to 47.5% against the end line target of 60% for weak States. 2 weak stateshave even achieved the national target of 60%. The DLHS-3 ( ) and the CES 2009 also show improvement in coverage of vulnerable groups: Scheduled Castes (41.9% at baseline to 52.6% in DLHS-3 and 58.9% in CES), Scheduled Tribes (36.5% at baseline to 45.5% indlhs-3 and 49.8% in CES) and also in the lowest wealth quintile (31.3% at baseline to 35.6% in DLHS-3 and 47.3% in CES). Text Value 45% (33% for 8 weak states) 47.9% 52% (40% for 8 weak states) (37.7% for 8 weak states) DLHS-3 ( ) indicated an overall improvement from base line of 45% to 47.9%. The number of states achieving the end line target of 52% also increased from 17 to19. For the 8 weak states there was an improvement from 33% at Page 4 of 8

5 baseline to 37.7% with 4/8 states above end line target of 40% for weak States. The DLHS-3 also shows improvement in coverage of vulnerable groups: Scheduled Castes (43% at baseline to 49% in DLHS-3), Scheduled Tribes (39% at baseline to 42% in DLHS-3). However the coverage for the lowest wealth quintile declined from 36.4% at baseline to 34% in DLHS-3). Percentage of deliveries conducted by skilled providers (doctors/anms/nurses) The (CES-2009) did not include this indicator. Text Value 48% (32% for 8 weak states) 76.2% (65.6% for 8 weak 60% (45% for 8 weak states) states) The results of UNICEF Coverage Evaluation survey (CES-2009) indicate an overall improvement from baseline of 48% ( ) to 76.2%in out of 29 States (6 Union Territories excluded) have achieved the overall end line target of 60%. For the 8 weak States there is a combined improvement from the baseline of 32% to 65.5% against the end line target of 45% for weak States. 4 weak states have even achieved the national target of 60%. The DLHS-3 ( ) and the CES 2009 also show marked improvement in coverage ofvulnerable groups: Scheduled Castes (39.6% at baseline to 47.7% in DLHS-3 and 75% in CES); Page 5 of 8

6 Intermediate Results Indicators Scheduled Tribes (28.4% at baseline to 37.6% in DLHS-3 and 61.3% in CES) and also in the lowest wealth quintile (27.5% at baseline to 23.6% in DLHS-3 and 59% in CES). Indicator Name Core Unit of Measure Baseline Current End Target Health personnel receiving training Number Value Cumulative number of Health Personnel having received training since start of project. In addition, number of community health volunteers (ASHAs) fully Up to Module VI & VII Upto Module IV No target envisaged for end of project since this is an incremental increase based on need. % of districts (in EAG States + Assam) having the following (i) District hospitals conducting at least 20 C-sections in a quarter (ii) At least one sub # district hospital conducting 10 C- sections in Stool Samples collected from at least 80% of acute flaccid paralysis cases within 14 days of reporting Percentage of districts not having at least one month stocks of measles vaccine, oral contraceptive pills and gloves Text Value NA Qr3(2011) (i) 49.1% (ii) (i) 80% (ii) 80% 40.9% Based on HMIS data for the number of districts actually reported on this indicator during a quarter-which may vary in each quarter. Text Value 82% 2 samples 91% 86% Any Sample 97% (For 2011 January to December 2011) Text Value Data currently not reported. 0% <5% Shortage noted during field visit. During the JRM-8 field visits, no districts were found to have a stock out of the critical items. Page 6 of 8

7 Percentage of States reporting quarterly financial performance and annual audit reports in time Percentage of State plans with specific activities to reach vulnerable groups Text Value 50% >90% 100% All States have sent financial reports upto 12/31/2010 (as per the NRHM bulletin). The quality of audit reports of FY have improved in majority of states as a result of the strengthened process of selection of auditors. 3/35 states are yet to submit audit reports. Text Value 0-49% 100% 75% All States have submitted NRHM plans in which RCH is a part. All plans have strategies to reach vulnerable groups as part of the RCH program. Data on Financial Performance (as of 14-Nov-2011) Financial Agreement(s) Key s Project Loan No. Status Approval Signing Effectiveness Original Closing Revised Closing P IDA Effective 16-Oct Nov-2006 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P IDA Effective XDR Disbursement Graph Page 7 of 8

8 Key Decisions Regarding Implementation The 8th Joint Review Mission held in July 2011 and the fifth Common Review Mission held in December 2011, measured performance in terms of results and implementation progress since 2005 as well as lessons learnt for the next plan period. The key findings are available in these reports, which were also shared in a dissemination event held in January The 8th Joint Review Mission made the following key recommendations going forward to the next five year plan, including amongst others : (i) all technical divisions related to RCH at the central level should continue to remain under a single administrative authority given the positive experience during the last year; (ii) the MOHFW should consider expanding the results based financing approach in the next five year plan cycle in a phased manner as it makes a more efficient use of funds as well as provides the impetus to achieve the necessary results; (iii) MoHFW should continue to use HMIS and MCTS data in the state program reviews; this would encourage states to do the same and accelerate the validation and use of data for monitoring and planning purposes; (iv) the state s comprehensive training plan (CTP) needs to be further strengthened to ensure that training plans are aligned with facility operationalization priorities and take into account training capacities in both public and private sectors; (v) states should focus on developing evidence-based BCC strategies and prioritize the range of behaviours they should target. A Monitoring and Evaluation framework for BCC needs to be established; and, (vi) Quality Assurance framework needs to be strengthened further to improve the quality of RCH services. Both reports are available in WB DOCs. Restructuring History Level two Approved on 03-May-2010, Level two Approved on 04-May-2010 Related Projects There are no related projects. Page 8 of 8