The World Bank Social Accountability Knowledge, Skills, Action and Networking (P147835)

Transcription

1 AFRICA Mozambique Governance Global Practice Recipient Executed Activities Investment Project Financing FY 2014 Seq No: 1 ARCHIVED on 25-Aug-2016 ISR23789 Implementing Agencies: Fonagni - Provincial Forum of Organizations from Niassa, Nafeza - Famale Association from Zambezia Key Dates Key Project Dates Bank Approval Date:20-Dec-2013 Original Closing Date:20-Dec-2018 Project Development Objectives Effectiveness Date:20-Dec-2013 Revised Closing Date:20-Dec-2018 Project Development Objective (from Project Appraisal Document) The objective is to improve quality of life of the most vulnerable (women, persons with disability, people with HIV etc.) in Niassa and Zambézia Provinces through enhanced social accountability and responsiveness to social needs of service delivery in the health sector. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO -- Satisfactory Overall Implementation Progress (IP) -- Satisfactory Implementation Status and Key Decisions The Project is helping to improve indicators in the areas of maternal and reproductive health and HIV treatment. The Niassa Provincial Directorate for Health has positive appreciation of the SAKSAN s performance in the area where the project is being implemented (Muembe, Marrupa and Maúa districts). In 2015, there was a marked improvement with regard to institutional births compared to the previous years. Improvement was particularly noted in the districts of Maúta (24,5%) and Muembe (13,5%) with a small decrease in Marupa (0,8%). On average, the coverage rate was 79% in the three districts where project is being implemented. With regard to non-institutional birth, there was a decrease in 2015 (352) compared to 2014 (988). 8/25/2016 Page 1 of 7

2 With regard to HIV treatment, the province had planned to register a total of 777 children (0-14 years) in the first nine months of 2015, although only 276 registries were achieved, representing 36% of the provincial target. With regard to adults, the provincial target was to register patients (15 years old and older), but only were achieved, representing 50% of the target. In general, from expected patients, only were achieved, representing 49%. The low performance on this indicator is due to weaknesses in the sanitary service, follow-up on the diagnosis with PCR, and link with care and treatment, etc. The provincial government is working to address the current situation through development and integration of the Plan for Pediatric Anti-Retroviral, among other plans. As for the new recipients of the antiretroviral treatment, the provincial government had targeted 389 children to start the treatment in the first semester of Of this number, only 232 children have actually started the treatment (60%). Some districts in the province had satisfactory performance: Majune (110%), Mecanhelas (97%), Lichinga (83%), and Muembe (78%). Despite this performance, other districts are lagging behind: Chimbunila (42%), Lago, Marrupula e Mecula (44%) respectively. For adults, 90% (3.393) of the target was met. Given the contribution of the SAKSAN project in improving service delivery in the health sector, mainly on maternal health and HIV care and treatment, the Niassa Provincial Directorate for Health has urged Concern Universal to scale-up the project to other districts so far not covered. 8/25/2016 Page 2 of 7

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4 Risks Overall Risk Rating Risk Category Rating at Approval Previous Rating Current Rating Overall Moderate -- Moderate Results Project Development Objective Indicators 8/25/2016 Page 4 of 7

5 PHINDPDOTBL Number of CBOs/CSOs representing vulnerable groups trained and using instruments of Social Accountability to monitor and influence delivery of health services. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Date 04-May Aug May-2017 PHINDPDOTBL Increasing engagement between supply and demand side actors on the quality of health service delivery (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Date 04-May Aug Apr-2017 Overall Comments Increase capacity of local CBOs/CSOs for social accountability engagement: Since the beginning of the Project, 105 CBOs/CSOs have been trained in internal governance principles (through the democratic dialogue/learning cycle approach), representing 100 percent of the planned target. The training sessions focused on issues of good governance, constructive evidence-based dialogue, and grass root evidence collection methods. Increase engagement between supply and demand side actors on the quality of health service delivery About 88 CBOs/CSOs in Niassa and Zambezia have been integrated into the District s CSO platforms after the official recognition of the groups by district governments. These groups are currently involved in the use of social accountability s tools for supervision of the health services. One of the most important activities that took place was the first Public Auditorium, a unique space for the promotion of dialogue and evidencebased engagement between civic groups and government, around health issues. This event took place on June 30, 2015 in Maúa district, Niassa Province, and counted over 200 people, including community representatives (Muevia, Necuto, Njane, Minicua, Namarica, Matoto, Wapala, Mutucula, Paia, Nveriua, Mutela, Quareia, Nerruculo and Maúa sede); district governments from Maúa, Muembe and Marrupa; the provincial health inspector; health officials; traditional leaders; traditional birth attendants; and members of the committees for civic health, among others. During the event, the civic group presented the findings identified in the health facilities and community members had the opportunity to interact in a frank and open manner with the district director for health, district administrator, and the representative of the Provincial Directorate for Health. Since the beginning of the Project, six (6) social audits have been undertaken in the health sector. Many of the findings presented were publicly recognized and adopted by the local government, which has shown a deep commitment to take corrective measures. Government officials at all levels (national, provincial, district) are actively participating in public auditorium promoted by the project and are bringing feedback to their superiors. For example after the health services users and members of civic groups in Nicoadala district demanded for improvement of service delivery in the pharmacy and complained about cases of corruption, the Provincial Governor called for an urgent meeting with the district health services in order to urgently address the problem. Another concrete action from the government can be observed in Maúa district, Niassa province where because of the demand demonstrated during public auditorium, the district government and district health services, accelerated the opening of a health unit that was ready for more than six months and was not open to the public. This action involved various actors at district, provincial and national levels. Currently the health unit is functioning and has improved significantly the lives of the communities that before had to walk several kilometers to access health services. Moreover, in Marrrupa district, Marangira community the public auditorium accelerated the process of construction of the maternity ward as the direct response to the complaints and evidence presented during the public auditorium. Intermediate Results Indicators 8/25/2016 Page 5 of 7

6 PHINDIRITBL Generate knowledge and sharing learning on social accountability (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Date 04-May Aug Apr-2018 Overall Comments In general, project milestones have been successfully delivered, external mid-term project evaluation completed; findings and recommendations integrated into project Action Plan and interim financial and narrative reports have been timely submitted. A full PDF version of the baseline (in English and Portuguese) can be accessed through the following link: Mid Term evaluation report (in Portuguese and English) can be accessed through the links: According to the Provincial Government in Niassa, represented by the Provincial Directorate for Health, the Project contributes to improving the quality and humanization of health as a result of the increasing involvement of communities in social accountability in the health sector. As evidence of the satisfactory results, the Niassa Provincial Directorate of Health sent a statement to Concern Universal recognizing the contribution of the SAKSAN project in improving access to and quality of health services in the province as well as requesting for the scaling-up of the project to other districts. According to the Niassa Provincial Directorate of Health, SAKSAM is helping to improve indicators in the areas of maternal and reproductive health and HIV treatment. Satisfactory performance has been identified in the following indicators: (i) institutional births; (ii) non-institutional births; (iii) child mortality rate; (iv) family planning consultations; (v) compliance with the target for the new registered for the pre-pediatric and adults; (vi) collaborative activities in the area of HIV care and treatment. The Project collaboration and engagement with the Government at both central and decentralized levels is very positive. Alignment with the legal framework and institutional policies and procedures is seen by the Project team as essential for the success of implementation of SAKSAN Project. Project activities are directly aligned with the Ministry of Health National Program for Improving Quality and Humanization of health service. The project has formalized the partnership with Government through signing of an MOU with the Niassa Provincial Directorate for Health as well as the performance agreement evaluated on an annual basis. The agreement stipulates as an obligation of the Provincial Directorate for Health to ensure active collaboration with SAKSAN Project in the promotion of social accountability and humanization of the health sector, with a focus on maternal and child health and antiretroviral treatment. GPSA Project has been very valuable for overall Concern Universal institutional strengthening as it provided many learning opportunities beneficial for wider organizational performance such as media training in March 2015, where SAKSAN researcher participated in SAMI Advocacy Media/Presentation Workshop that took place in Aga Khan University Graduate School of Media & Communications in Nairobi. That participation helped strengthen Concern Universal media and communications strategies, plans and skills in traditional and new media. Moreover the project is contributing to strengthening the organizational capacity of implementing partner s forums (FONAGNI and NAFEZA) as well as its member organizations. In general the Project improved the ability of FONAGNI and NAFEZA to intervene and influence. The project introduced the tool of annual assessment of partnership, where local partners have opportunity to in an open and frank manner give their suggestions and recommendations on how to improve the collaboration between Concern Universals and their organization. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P TF Effective USD % Key Dates (by loan) 8/25/2016 Page 6 of 7

7 Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P TF Effective 20-Dec Dec Dec Dec Dec-2018 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 8/25/2016 Page 7 of 7