Implementation Status & Results Mozambique Health Commodity Security Project (P121060)

Transcription

1 Public Disclosure Authorized Public Disclosure Authorized The World Bank Implementation Status & Results Mozambique Health Commodity Security Project (P121060) Operation Name: Health Commodity Security Project (P121060) Project Stage: Implementation Seq.No: 6 Status: ARCHIVED Archive : Country: Mozambique Approval FY: 2011 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key s Board Approval 30-Sep-2010 Original Closing 31-Dec-2012 Planned Mid Term Review 29-Nov-2011 Last Archived ISR 24-Jun-2013 Effectiveness 15-Feb-2011 Revised Closing Actual Mid Term Review 11-Dec-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objective of the proposed project is to improve the availability of selected drugs and medical supplies in Key Distribution Points in the Recipient's territory. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) losure Authorized Public Disclosure Authorized Component Name Component Cost Provision of Essential Health Commodities Strengthening Supply Chain Management 4.50 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 Substantial Moderate Implementation Status Overview The Health Commodity Security Project was designed to assist in reducing the impact of the financial crisis of 2008 and the unpredictable financing on the availability of select public health commodities. It was prepared in accordance with the Crisis Response Window (CRW) guidelines as a 2 year project. It became effective on February 11, 2010, and the closing date was subsequently extended from December 31, 2012 to December 31, During the crisis, the country was significantly affected with the level of foreign development assistance (both program and project) below projections at 1.6% of GDP, and project aid substantially lower than the pre-financial-crisis projections of 2.5% of GDP, leading to major financing gap of select medicines and medical supplies especially related to public health. Page 1 of 5

2 The development objective of the project is to improve the availability of selected drugs and medical supplies in key distribution points. It includes two components; The first is focused on the provision of essential health commodities and the second on strengthening supply chain management. The project has surpassed all of its project development outcome (PDO) indicator targets. Order fulfillment rates, a proxy of commodity availability; reached between 95 percent and 98 percent, much higher than the planned targets of 75 percent and 85 percent. For Depo-Provera, an injectable contraceptive and popular among women, the fill rate in 2011, prior to the availability of IDA-financed products, was at 63 percent; once the products arrived into the country in 2012, the fill rate was maintained between 91 to 100 percent. For first-line ARVs, the fill rates for 2011 was 96%, 2012, 97% and 100% for the first three quarters of For malaria control, the project supported the procurement of almost 2.5 million longlasting insecticide-treated bed nets (LLINs) which have been or are planned to be distributed in five endemic provinces. In sites where the nets have been distributed, the project has achieved household coverage rates of 95 percent and above. The project has disbursed over 95 percent of its funds. This is the highest disbursement achieved in the current World Bank financed Mozambique portfolio. The achievements have not come easy. The project faced multiple risks. However the Ministry of Health (MOH) has shown proactive leadership and taken the necessary steps to address risks identified during the implementation phase, including: (i) instituting a coordinating mechanism to mitigate the risks of a fragmented supply chain; (ii) seeking technical assistance through other donors to assist in the data mining for the Results Framework; and (iii) instituting a team of people to daily manage the delays in procurement processes, directly reporting to senior management. The project was also helped by the strong support of partners (United National Children's Fund (UNICEF), United Nations Population Fund (UNFPA), United States Agency for International Development (USAID), President's Initiative on HIV/AIDS (PEPFAR), The Global Fund (GF), Partnership of Supply Chain Management (PfSCMS) and Center for Disease Control (CDC)) providing a coordinated effort in the management of the supplies, moving shipments backwards and forwards in order not to overstock or under-stock the pipeline and can be considered best practice and a lesson for many of the public sector supply chains facing similar challenges of fragmented acquisitions. In the case of first-line ARVs, once the commodities financed under the project were successfully procured and delivered to the central medical stores and incorporated in the inventory, CMAM was able to maintain an average 5.0 months of stock (MOS) in its pipeline for 2011 (which is above the minimum requirement of 4 MOS and below the maximum requirement of 9 MOS). In the preceding year in 2010, the system had an average of 3.72 MOS. In 2012, the system maintained an average of 4.2 MOS for year. It is anticipated that the average of 3.4 MOS in 2013 will drop. This is mainly due to the fact that consumption doubled in 2012 compared to 2010 as a result of the Ministry's commitment to accelerate and place more people with HIV on treatment. The second component of strengthening the supply chain, which represents 12 percent of the overall project financing, faced numerous procurement delays. These challenges are due to the broader, systemic public sector procurement issues that is impacting the entire Mozambique portfolio (and that the country office is addressing across the board) and also due to internal procedural delays within the Ministry of Health. These procurement delays for computers and trucks are having a significant impact on the expansion and roll-out of the LMIS to the district level and the strengthening of the distribution function between the provinces and the districts. Locations No Location data has been entered Results Project Development Objective Indicators Page 2 of 5

3 Indicator Name Core Unit of Measure Baseline Current End Target ARVs ordered that are delivered to health Percentage Value facilities. The indicator is based on the Target achieved. CMAM MAC Lamivudine 150mg+ most used first line ARV. system (ERP). Zidovudine 300mg +Nevirapine 200 Note: The baseline and endtarget are the same as the aim of the project was to maintain the availability over the course of the crisis period. Injectable contraceptives ordered that are Percentage Value delivered to provinces. 30-Nov-2010 CMAM ERP system Target achieved. The end target and baseline are the same because the aim of the project was to ensure that the availability was maintained during the years of the financial crisis. Long-lasting insecticide-treated malaria nets Number Value purchased and/or distributed (number) 88% of the total has been distributed to households achieving a 98 coverage rate in three provinces ARVs received Number Value Number of patients receiving ARVs financed by the Project. Hence the target is 0.00 The number treated was higher than initial targets, due to some savings, that enabled the Ministry to purchase additional ARVs. Direct project beneficiaries Number Value Female beneficiaries Percentage Sub Type Supplemental Value Intermediate Results Indicators Page 3 of 5

4 Indicator Name Core Unit of Measure Baseline Current End Target Number of orders received according to the Number Value agreed schedule in the contracts. 30-Jun-2010 This number is best represented as a percentage rather than a number as the 31-Dec-2012 Data requires additional analysis 80% of the contracts received in the time agreed in the schedule. number of orders are continually on the increase Percentage of supplier lead time variability Percentage Value May-2013 Data received requires additional analysis National fleet management plan completed. Text Value No No Yes Districts using a computerized LMIS Number Value Jun-2010 Data on Financial Performance (as of 16-Dec-2013) Financial Agreement(s) Key s Project Ln/Cr/Tf Status Approval Signing Effectiveness Original Closing Revised Closing P IDA Effective 30-Sep Nov Feb Dec-2012 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P IDA Effective XDR Disbursement Graph Page 4 of 5

5 Key Decisions Regarding Implementation The project is coming to a close in December 31, The Government of Mozambique has requested a six month extension to June 30, 2014 in order to provide additional time for the remaining contracts to be awarded and or delivered leading to fully disbursed credit. The Project was designed under the pilot Crisis Response Window (CRW) to provide urgent and predictable stop-gap financing to the Government of Mozambique to mitigate the fallout of the global financial crisis of 2008 on the availability of key public health commodities. The project has served its intended purpose by assuring that the central medical stores was able to fulfill the demand for these commodities. Restructuring History Level two Approved on 03-Oct-2012 Related Projects There are no related projects. Page 5 of 5