Public Disclosure Authorized Public Disclosure Copy AFRICA South Sudan Health, Nutrition & Population Global Practice Special Financing Emergency Recovery Loan FY 2012 Seq No: 7 ARCHIVED on 23-Dec-2015 ISR21469 Implementing Agencies: Ministry of Health Public Disclosure Authorized Key Dates Key Project Dates Bank Approval Date:13-Apr-2012 Planned Mid Term Review Date:15-Jun-2015 Original Closing Date:31-Oct-2014 Project Development Objectives Effectiveness Date:02-Aug-2012 Actual Mid-Term Review Date:15-Jun-2015 Revised Closing Date:30-Jun-2016 Public Disclosure Authorized Project Development Objective (from Project Appraisal Document) The project development objectives (PDOs) are(i) to improve the delivery of high impact primary health care services in Recipient'sstates of Jonglei and Upper Nile; and (ii) to strengthen coordination and monitoring and evaluation capacities of the Ministry of Health. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Public Disclosure Authorized Name Component 1: Delivery of high impact Primary Health Care services in Jonglei and Upper Nile State:(Cost $23.00 M) Component 2: Capacity development of MOH at the national level:(cost $5.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating -- High Implementation Status and Key Decisions Page 1 of 9
The Implementation performance and progress towards Project Development Objectives are both satisfactory. The Health Rapid Results Project (US$28 million) was approved on April 13, 2012 and became effective on August 2, 2012. An Additional Financing (AF) in the amount of US$35 million was approved on March 13, 2014 and the project closing date was extended to June 30, 2016. The project has two components: Component 1- delivery of high impact Primary Health Care Services; and Component 2 - to strengthen coordination and monitoring and evaluation capacities of the Ministry of Health. Support for service delivery in Upper Nile and Jonglei states began in February 2013 following the signing of the Ministry of Health Inter-church Medical Assistance (IMA) contract. The Bank conducted a Midterm Review (MTR) between June 15 and July 28, 2015. The MTR results are feeding into the discussion on the future health portfolio and the preparation of a new AF. The MTR found that the current overall PDO remains relevant but more indicators need to be introduced for the second PDO to improve its tracking. In addition, contracting of County health departments by the coordinating and service delivery organization (IMA) has shown to improve overall capacity building in the counties. This is seen as the best way forward. Fiscal challenges, insecurity and conflict, including inadequate human resources, were noted as major challenges. Concurrent with the MTR, a sector Public Expenditure Review for South Sudan was also undertaken to look at the availability of services, Government s own efforts in funding health care and the overall financial flows. Page 2 of 9
Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- -- High Macroeconomic -- -- High Sector Strategies and Policies -- -- Substantial Page 3 of 9
Technical Design of Project or Program -- -- Moderate Institutional Capacity for Implementation and Sustainability -- -- High Fiduciary -- -- High Environment and Social -- -- Moderate Stakeholders -- -- Moderate Other -- -- Substantial Overall -- -- High Results Project Development Objective Indicators Number of children under 12 months immunized against DPT3 (Number, Custom) Value 16986.00 47287.00 37490.00 21595.00 Date 15-Jun-2011 31-Dec-2013 31-Aug-2015 30-Jun-2016 Pregnant women receiving antenatal care during a visit to a health provider (number) (Number, Core) Value 21180.00 49163.00 55716.00 28455.00 Date 15-Jun-2011 31-Dec-2013 31-Aug-2015 30-Jun-2016 Percentage of functional health facilities submitting standardized HMIS monthly reports within one month of the reporting month (Percentage, Custom) Value 62.00 90.80 71.50 80.00 Date 06-Apr-2012 31-Dec-2013 31-Aug-2015 30-Jun-2016 Outpatient visits per capita per year (Percentage, Custom) Page 4 of 9
Public Disclosure Copy Value 0.10 0.40 0.49 0.40 Date 06-Apr-2012 31-Dec-2013 31-Aug-2015 30-Jun-2016 Percentage of direct beneficieries of which female (Percentage, Custom) Value -- -- 53.00 50.00 Date -- -- 31-Aug-2015 30-Jun-2016 Overall Its important to note that despite the ongoing conflict and challenges in implementation, four of the five PDO indicators have been met. Progress to meeting the fifth one is on course. Global Environmental Objective Indicators Overall Intermediate Results Indicators Children 6-59 months receiving a dose of vitamine A (Number, Custom) Value 18074.00 370357.00 243013.00 22400.00 Date 15-Jun-2011 30-Jun-2013 31-Aug-2015 30-Jun-2016 Despite impact of civil conflict target still attained. Target will be revised in AF Page 5 of 9
Public Disclosure Copy Number of children who received measles vaccination 59 months of age (Number, Custom) Value 97857.00 73715.00 65570.00 106560.00 Date 15-Jun-2011 31-Dec-2013 31-Aug-2015 30-Jun-2016 Impact of civil conflict on dry season campaign Births (deliveries) attended by skilled health personnel (number) (Number, Core) Value 13827.00 11835.00 5084.00 16345.00 Date 15-Jun-2011 31-Dec-2013 31-Aug-2015 30-Jun-2016 The impact of the conflict and insecurity war on health facilities and personnel after the escalation of the war in December 2013. Long-lasting insecticide-treated malaria nets purchased and/or distributed (number) (Number, Core) Value 126451.00 2534785.00 2534785.00 150960.00 Date 06-Apr-2012 31-Oct-2014 31-Oct-2014 30-Jun-2016 This indicator shows the target has been exceed. This includes LLINs from both campaign and routine distribution procured by GFATM and distributed through resources supported by the Bank. We do not procure LLINs within the HRRP. Page 6 of 9
Public Disclosure Copy Percentage of health facilities having essential drugs at the time of supervisory visit (Percentage, Custom) Value 50.00 55.00 57.00 80.00 Date 06-Apr-2012 30-Sep-2013 31-Aug-2015 30-Jun-2016 Progress on course despite the conflict. However not all facilities provided reports due to the conflict. Percentage of health facilities with structured supervision visit (using QSC) within a month before a verification visit (Percentage, Custom) Value 25.00 71.00 54.00 37.00 Date 06-Apr-2012 31-Dec-2013 31-Aug-2015 30-Jun-2016 This will be revised in the AF. Target surpassed Percentage of children aged 0-59 months living under a LLIN the night before survey. (Percentage, Custom) Value 34.20 -- 26.80 40.00 Date 01-Jan-2013 -- 31-Aug-2015 -- Percentage of skilled health centres with at least two skilled health workers. (Percentage, Custom) Value 50.00 -- 58.00 32.00 Date 01-Jan-2013 -- 31-Aug-2015 30-Jun-2016 This will be revised in the AF. Target attained Page 7 of 9
Overall Progress towards attaining Intermediate outcome indicators is on course. The impact on those indicators that require infrastructure and other health system related inputs is negatively impacted by the civil strife and conflict especially the one on delivery in health facilities.. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P127187 IDA-54010 Effective USD 10.00 10.00 0.00 2.99 6.28 30% P127187 IDA-H9210 Effective USD 25.00 25.00 0.00 23.54 0.18 94% P127187 TF-12272 Effective USD 28.00 28.00 0.00 27.96 0.04 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P127187 IDA-54010 Effective 13-Mar-2014 09-May-2014 09-Sep-2014 31-Oct-2015 30-Jun-2016 P127187 IDA-H9210 Effective 13-Mar-2014 09-May-2014 09-Sep-2014 31-Oct-2015 30-Jun-2016 P127187 TF-12272 Effective 20-Apr-2012 20-Apr-2012 02-Aug-2012 31-Oct-2014 30-Jun-2016 Cumulative Disbursements Page 8 of 9
Restructuring History Level 2 Approved on 22-Jun-2015 Related Project(s) P146413-South Sudan Health Rapid Results AF,P156917- South Sudan Health Rapid Resuts Project AF Page 9 of 9