Implementation Status & Results Guatemala GUATEMALA Maternal and Infant Health and Nutrition (P077756)

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1 Public Disclosure Authorized Public Disclosure Authorized The World Bank Implementation Status & Results Guatemala GUATEMALA Maternal and Infant Health and Nutrition (P077756) Operation Name: GUATEMALA Maternal and Infant Health and Nutrition Project Stage: Implementation Seq.No: 18 Status: ARCHIVED Archive : 09-Nov-2012 (P077756) Country: Guatemala Approval FY: 2006 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of Health Key s Board Approval 19-Jan-2006 Original Closing 30-Jun-2011 Planned Mid Term Review 23-Nov-2009 Last Archived ISR 22-Mar-2012 Effectiveness 26-Jun-2007 Revised Closing Actual Mid Term Review 06-Nov-2009 Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed Project aims to support the Government of Guatemala to: (a) improve maternal and infant health in the project's 40 areas of intervention; and (b) reduce chronic malnutrition among children younger than 2 years of age in the rural areas of the 70 municipalities targeted by the project. 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 Component I. Strengthening of Maternal and Infant Health Network Component II. Nutrition-Implementation of the AINM-C and "Creciendo Bien" Strategy Component III. Communication, Monitoring, Evaluation and Continuous Auditing Systems Component IV. Institutional Strengthening 1.63 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 The Project has achieved a number of its targets. In particular, the percentage of institutional births in Project intervention areas, the percentage reduction in the indigenous to non indigenous maternal mortality ratio, the number of jurisdictions with AINM-C, and the percentage of families that were attended by the Creciendo Bien Program - when it still existed as a separate program - have surpassed their targets. In addition, the Project has developed and has been implementing an integrated strategy for Community- based Integrated Page 1 of 8

2 Care for Children and Women (AINM-C) that is linked with efforts to improve the quality of primary and secondary levels of care. Other notable achievements by the Project include the development and ongoing implementation of a multi-cultural communication strategy to promote maternal-child health and nutrition and culturally sensitive messages and interventions, and the establishment of a Communications Resources Bank which is available for use to all local agencies working on maternal-child health issues. The Project has also been requested to share its communication strategy and materials by some countries in the region and by external agencies. The number of secondary level facilities rehabilitated, equipped and staffed increased from 29 in late 2011 to 33 by June 2012 and an additional health care center was rehabilitated by August The Government has assumed responsibility for ensuring the continuity of AINM-C interventions through the Expansion of Coverage Program (PEC) by financing community educators who serve as the important links between health staff and communities in 146 jurisdictions that used to be financed by the Project. At present, the Project is implementing AINM-C provided by Ministry of Health teams in 216 communities in 9 municipal districts. Locations Country First Administrative Division Location Planned Actual Guatemala Not Entered Municipio de Uspantán Guatemala Not Entered Municipio de Tejutla Guatemala Not Entered Tanchí Guatemala Not Entered Municipio de Soloma Guatemala Not Entered Municipio de Sibilia Guatemala Not Entered Sibilá Guatemala Not Entered Municipio de Santa María Chiquimula Guatemala Not Entered Santa Lucía Cotzumalguapa Guatemala Not Entered Municipio de San Pedro Pinula Guatemala Not Entered Municipio de San Luis Guatemala Not Entered Municipio de San Juan Tecuaco Guatemala Not Entered Municipio de San José del Golfo Guatemala Not Entered Municipio de San Carlos Sija Guatemala Not Entered San Andrés Sajcabajá Guatemala Not Entered San Agustín Acasaguastlán Guatemala Not Entered Municipio de Rabinal Guatemala Not Entered Municipio de Pueblo Nuevo Viñas Page 2 of 8

3 Country First Administrative Division Location Planned Actual Guatemala Not Entered Municipio de Pochuta Guatemala Not Entered Municipio de Patulul Guatemala Not Entered Municipio de Olopa Guatemala Not Entered Municipio de Nentón Guatemala Not Entered Municipio de Nahualá Guatemala Not Entered Municipio de Momostenango Guatemala Not Entered Momostenango Guatemala Not Entered Mataquescuintla Guatemala Not Entered Municipio de Lívingston Guatemala Not Entered Municipio de La Libertad Guatemala Not Entered Municipio de Jocotán Guatemala Not Entered Ixcán Guatemala Not Entered Finca El Refugio Guatemala Not Entered El Jícaro Guatemala Not Entered Municipio de El Estor Guatemala Not Entered El Chal Guatemala Not Entered Municipio de Cuyotenango Guatemala Not Entered Municipio de Comitancillo Guatemala Not Entered Comapa Guatemala Not Entered Municipio de Chisec Guatemala Not Entered Municipio de Champerico Guatemala Not Entered Municipio de Chajul Guatemala Not Entered Chacté Guatemala Not Entered Municipio de Cahabón Guatemala Not Entered Barrios Page 3 of 8

4 Guatemala Not Entered Amatillo Guatemala Not Entered Municipio de Alotenango Guatemala Not Entered Acatenango Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Indigenous/non indigenous infant mortality ratio in project area. Indigenous/non indigenous maternal mortality ratio in project area. Percentage of institutional deliveries in the areas of intervention. Percentage of children under 2 with weight for age <-2Z in project areas. Text Value Reduce by 10 percent with respect to the baseline. 31-Dec Dec-2009 Latest available reliable data is from Improved from 2008 but slightly higher than 2007 data. The Project's actual implementation started in mid-2008 even though it became effective in Text Value Reduce by 10 percent with respect to the baseline. 31-Dec-2009 Target surpassed. Latest available reliable data is from end Based on INE Statistics Text Value 22.3% 31% Increase by 20 percent with respect to the baseline. 30-Apr-2012 Target surpassed (increase is 40%) as early as first trimester of Data from MOH SIGSA. Text Value 40% 21.9 (2008 cohort) and 27.4 (2009 cohort) 30-Jun Mar-2011 Based on survey conducted from Oct to March Increase by 15 percentage points with respect to baseline. Page 4 of 8

5 Percentage of children under 2 with height for age <-2Z in project areas Given that the 2006 data were only extrapolated, the Project considers thedata obtained from the survey as the real baseline for the Project areas. Follow-up survey to be conducted early Text Value (2008 cohort) and 78.3% (2009 cohort) 30-Jun Mar-2011 Based on survey conducted from Oct to March Given that the 2006 nutritional data were only extrapolated, the Project considers the data obtained from the survey as the real baseline for the Project areas. Follow up survey to be conducted early Increase by 10 percentage points with respect to baseline. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of Secondary level services with Text Value areas cartera ampliada and operating room fully 01-Jul-2013 operational. Increased. Target revised from 8 to 12 to take into account Project's strategic decision to provide more areas with improved health facilitiesthat provide surgical services especially emergency obstetric care. Number of secondary level services with Text Value areas cartera ampliada, but without operating room, 30-Jun-2012 fully operational. Increased. Target revised from 32 to 28 Comment: Please note that previous ISR had a typographical error. It should to support more areas with more CAIMI to improve access to surgical services than CAP while maintaining Page 5 of 8

6 Percentage of pregnant women with at least one prenatal care in project areas. Percentage of mothers receiving post-natal case within 10 days of delivery in the areas of intervention (information to be gatheredfrom CAIMI and PEC). Percentage of children under 2 years old who participate in the weighing sessions in the areas of intervention. Percentage of children for whom change in weight is measured in the areas of intervention. Percentage of families attended by Creciendo Bien in areas of intervention. Integrated strategy for the implementation of the three programs. have referred to 24 CAP and not 28 CAP. the total number of rehabilitated health facilities. Text Value 54.2% 23% 100 percent 30-Jun Apr-2012 Indicator on track considering available figure is just for the 1st trimester of 2012 Text Value 0% 10% 20 percent 30-Apr-2012 Earlier ISR had listed this as On track considering figure 45.54% but that was a presented is only for first typographical error. The PAD trimester of the year. and other project docs indicate that this should be 0 Text Value 55% 76% 85 percent 30-Dec-2011 On track Text Value 0% 76% 85 percent 30-Dec-2011 On track. Text Value 0% Not applicable since the 30% of total beneficiaries program no longer exists but it reached 100% in Dec-2010 Target surpassed for last applicable period. After 2010, this program has been included as part of another program and is no longermonitored as an individual program. Text Value N/A Available Available 18-Mar-2011 Target achieved Number of jurisdictions with AINM-C. Text Value jurisdictions. 30-Jun Jul-2012 Target surpassed. Government is now supporting 146 jurisdictions Page 6 of 8

7 People with access to a basic package of health, nutrition, or reproductive health services (number) Health facilities constructed, renovated, and/or equipped (number) with AINM-C by financing community educators who link health staff and communities through the PEC. Number Value Nov Dec-2011 Total number of people with access is 950,000, of which 159,604 are children less than 5 years old. Number Value Nov Aug-2012 On track. All 34 facilities are functioning although 1 still needs to be fully equipped. Health personnel receiving training (number) Number Value Nov May-2012 On track considering that data is just for first 5 months of Data on Financial Performance (as of 23-Jul-2012) Financial Agreement(s) Key s Project Ln/Cr/Tf Status Approval Signing Effectiveness Original Closing Revised Closing P IBRD Effective 19-Jan May Jun Jun-2011 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P IBRD Effective USD Disbursement Graph Page 7 of 8

8 Key Decisions Regarding Implementation The Government of Guatemala has requested for an extension of the Project closing date. Restructuring History Level two Approved on 14-Feb-2011, Level two Approved on 18-Feb-2011 Related Projects There are no related projects. Page 8 of 8