Public Disclosure Authorized LATIN AMERICA AND CARIBBEAN Peru Social Protection Global Practice IBRD/IDA Specific Investment Loan FY 2011 Seq No: 7 ARCHIVED on 04-Feb-2015 ISR17689 Implementing Agencies: Ministry of Finance Public Disclosure Authorized Key Dates Key Project Dates Board Approval date:08-mar-2011 Planned Mid Term Review Date:15-Apr-2015 Original Closing Date:31-Mar-2016 Project Development Objectives Effectiveness Date:12-Jan-2012 Actual Mid-Term Review Date:-- Revised Closing Date:31-Mar-2016 Public Disclosure Authorized Project Development Objective (from Project Appraisal Document) The proposed operation has been designed to support the demand, supply, and governance of nutrition services provided by the Government of Peru (GoP), organized under the Articulated Nutrition Program (PAN). The objectives of the proposed operation are to: (i) increase demand for nutrition services by strengthening the operational effectiveness of the Juntos Conditional Cash Transfer (CCT) program; and (ii) improve coverage and quality of the supply of basic preventive health and nutrition services in the communities covered under the PAN including Juntos. Activities to support both objectives include a strong emphasis in promoting good governance to monitor the impact of the Government Programs and of the proposed intervention in nutrition outcomes. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Public Disclosure Authorized Name Component 1: Strengthening and consolidating of the Juntos CCT program for families with children under 36 months.:(cost $5.50 M) Component 2: Improving coverage and quality of the provision of basic preventive health and nutrition services in the Juntos areas.:(cost $5.50 M) Component 3: Strengthen the GoP's capacity to influence nutritional outcomes by improving budgetary planning and monitoring of resul ts for selected activities of the PAN.:(Cost $14.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory 2/4/2015 Page 1 of 8
Overall Risk Rating -- Moderate Implementation Status and Key Decisions Based on the monitoring indicators, progress towards development objectives slowed down in 2014. Both PDOs have been affected equally by the fall in affiliations to SIS. However, there were encouraging positive trends in growth promotion check-ups (CRED) in rural areas during the first half of the year (from 58.1 percent in 2013 to 61.6 percent in 2014S1). The Project contributed to the strengthening of the governance for nutrition services through the implementation of a social monitoring platform with local governments. In the second part of 2014, 80 districts created local committees and were trained by MEF consultants in the use of basic monitoring indicators. In addition, 35 of the 80 districts organized accountability forums in their communities to present key nutrition-related results and receive feedback from local decision leaders. A technical supervision mission was held in November 2014 to review Project implementation with technical teams from MEF, the Juntos Conditional Cash Transfer Program and the social health insurance (SIS Seguro Integral de Salud). The mission included a field trip to Cajamarca to observe progress in the implementation of social monitoring. After the supervision mission the team felt positive about the direction of project activities, particularly with respect to the governance of nutrition services. Based on the expected results and the revision of unit costs the team expects disbursement to accelerate in the last part of project implementation. A more accurate analysis will be carried out during midterm review which is expected in April 2015. The second disbursement request is expected to be received in the beginning of 2015. 2/4/2015 Page 2 of 8
Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- -- Low Macroeconomic -- -- Low Sector Strategies and Policies -- -- Moderate Technical Design of Project or Program -- -- Moderate Institutional Capacity for Implementation and Sustainability -- -- Substantial Fiduciary -- -- Moderate Environment and Social -- -- Low Stakeholders -- -- Low Other -- -- -- Overall -- -- Moderate Results Project Development Objective Indicators PHINDPDOTBL % of Juntos Children under 12 months that have received the complete CRED scheme according to their age in the areas of intervention of the Juntos CCT Program targeted by this operation. (Percentage, Custom) Value 63.90 64.20 64.20 80.00 2/4/2015 Page 3 of 8
2012: 67.9%. Data for 2014 will be released in early February and will be updated in the next ISR. PHINDPDOTBL % of Children under 36 months that have received complete CRED scheme according to their age in the areas of intervention (Percentage, Custom) Value 71.70 66.90 66.90 73.00 2012: 67.2%. Data for 2014 will be released in early February and will be updated in the next ISR. Overall ENDES 2014 data (used to monitor PDOs) has not been released yet (expected in early February). Some administrative data is available for 2014 to monitor the intermediate results but most of the information will be updated in April when the new project progress report is expected. In the meantime, coverage of Juntos children younger than 12 months who received a complete CRED check-up scheme suffered an important drop between 2012 and 2013 due to several factors. First of all, the new conditions for the affiliation to the health insurance scheme (SIS) led to a generalized fall in affiliations to SIS and in the participation of the poor to preventive health services. Second, the Juntos program, partly because of the numerous changes in its management team, has not made great progress in the consolidation of the verification of health and nutrition coresponsibilities. The team expects indicators to have improved in 2014 following the actions of the new management team. The second PDO indicator has the objective of monitoring the sustainability of good coverage of supply of health and nutrition services in the three regions of intervention of the project. It has again suffered a fall due to the fall in SIS affiliations but data for 2014 are expected to have improved. Intermediate Results Indicators Percentage of Juntos beneficiary children under 24 months registered in the Juntos information system (SITC) with birth certificate, identity document or CUI, and SIS affiliation. (Percentage, Custom) Value 18.00 76.90 76.90 90.00 2/4/2015 Page 4 of 8
Percentage of children born each year in Juntos households and registered in the SITC before 30 days. (Percentage, Custom) Value 9.55 33.00 33.00 40.00 Percentage of Children younger than 36 months affiliated to SIS and with complete and timely CRED scheme in the areas of intervention of Juntos in Amazonas, Cajamarca and Huánuco. (Percentage, Custom) Value 43.00 44.80 54.64 65.00 Date 31-Dec-2011 31-Dec-2013 31-Dec-2014 31-Mar-2016 Percentage of mothers in Juntos families, with children under 24 months, who have assisted at least to one demonstrative session inamazonas, Cajamarca and Huánuco. (Percentage, Custom) Value -- -- -- 50.00 Date -- -- -- 31-Mar-2016 Thanks to the project the new Demographic Health Survey ENDES survey has started to monitor this indicator in Peru for the first time. Data are expected to be ready in February. Percentage of health facilities with basic equipment to give CRED and vaccines in Juntos districts (Percentage, Custom) Value 0.00 0.00 0.00 40.00 This data is being collected for the first time as part of the project and is expected to be available by April 2015. 2/4/2015 Page 5 of 8
Percentage of health facilities with updated and complete asset information in SIGA (Percentage, Custom) Value 98.40 97.00 100.00 100.00 Date 31-Dec-2011 31-Dec-2013 31-Dec-2014 31-Mar-2016 Number of districts in the first quintile where there have been discussion forums about CRED coverage and vaccines (social monitoring) and are registered on MEF s web page (Number, Custom) Value 0.00 0.00 72.00 75.00 Date -- 31-Dec-2012 01-Dec-2014 31-Mar-2016 Percentage of health micro-networks annually verified because they meet the certification criteria in Amazonas, Cajamarca and Huánuco (Percentage, Custom) Value -- -- 33.20 60.00 Date -- -- 31-May-2014 31-Mar-2016 The project supported the creation of the ENCRED survey which is verifying the capacity of health micro-networks. A health micro-network meets the certification criteria when it meets at least 60 percent of the defined conditions. Number of newborns registered in SIS before 30 days in Juntos districts in the areas of intervention of the operation. (Number, Custom) Value 11759.00 937.00 5696.00 15000.00 Date 31-Dec-2011 31-Dec-2013 03-Sep-2014 31-Mar-2016 Overall This information is preliminary and needs to be reviewed. There have been changes in the Juntos districts. The dramatic drop is explained by 2/4/2015 Page 6 of 8
the new criteria for affiliation to SIS (identity and having passed through the targeting system). Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P117310 IBRD-79610 Effective USD 25.00 25.00 0.00 7.28 17.72 29% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P117310 IBRD-79610 Effective 08-Mar-2011 05-Jul-2011 12-Jan-2012 31-Mar-2016 31-Mar-2016 Cumulative Disbursements Restructuring History Level 2 Approved on 10-Jul-2013,Level 2 Approved on 26-Feb-2014,Level 2 Approved on 26-Nov-2014 2/4/2015 Page 7 of 8
Related Project(s) There are no related projects. 2/4/2015 Page 8 of 8