Public Disclosure Authorized EUROPE AND CENTRAL ASIA Tajikistan Health, Nutrition & Population Global Practice IBRD/IDA Investment Project Financing FY 2014 Seq No: 9 ARCHIVED on 20-Nov-2017 ISR29997 Implementing Agencies: Ministry of Health & Social Protection, Ministry of Finance, Ministry of Health & Social Protection Public Disclosure Authorized Key Dates Key Project Dates Bank Approval Date:30-Jul-2013 Planned Mid Term Review Date:27-Mar-2017 Original Closing Date:31-Jan-2019 Project Development Objectives Effectiveness Date:11-Dec-2013 Actual Mid-Term Review Date:27-Mar-2017 Revised Closing Date:31-Dec-2019 Public Disclosure Authorized Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to contribute to the improvement of the coverage and quality of basic primary health care (PHC) services in rural health facilities in selected districts. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured)phrpdodel The revised PDO is to contribute to the improvement of the coverage and quality of basic primary health care (PHC) services in selected districts. Components Public Disclosure Authorized Name Component 1: Performance Based Financing:(Cost $13.96 M) Component 2: Primary Health Care Strengthening:(Cost $14.30 M) Component 3: Project Management, Coordination, and Monitoring & Evaluation:(Cost $4.81 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial 11/20/2017 Page 1 of 10
Implementation Status and Key Decisions Overall, all components of the project are progressing as scheduled. Over the first nine months of 2017, the project has been using the revised Performance-based Financing (PBF) manual. The Project Implementation Unit has been advised to consistently monitor response to changes in payment schemes and identify issues that need to be addressed. The project has achieved its targets for both Family Medicine and Continuous Medical Education programs as follows: (i) 617 doctors and nurses in total were re-trained in the six-month courses on Family Medicine (245 in Khatlon, 314 in Soghd, 58 in Faizabad); (ii) 1,860 doctors and nurses were trained in the four-day training courses on various clinical subjects; and (iii) 800 clinical and non-clinical staff were trained in computer literacy program, Collaborative Quality Improvement (CQI), supervision and other non-clinical areas. The implementation of CQI has shown positive progress, with necessary CQI tools available in the visited facility and staff trained on how to use these tools. The physical infrastructure improvement program continues to be implemented without delays. The first batch of facilities are expected to be completed by end of 2017. The design and engineering team was advised to continue to pay special attention to supervision and construction quality. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Substantial Substantial Sector Strategies and Policies -- Moderate Moderate Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Moderate Moderate Fiduciary -- Substantial High Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial Substantial Results Project Development Objective Indicators PHINDPDOTBL Percentage of pregnant women receiving antenatal care four or more times from a skilled health provider (Text, Custom) Value Sogd: 79.2%; Khatlon: 39.2%, 78.7% RRS Sogd: 85%; Khatlon: 45%, 82% RRS 11/20/2017 Page 2 of 10
Date 31-Dec-2012 27-Mar-2017 20-Oct-2017 31-Dec-2019 Demographic and Health Survey (2012) was used to establish the baseline. Data from next DHS to measure progress will become available around September 2018. Routine project data is also unavailable at this point because necessary input data would be entered in the Performance-Based Financing information system by the end of 2017 calendar year. PHINDPDOTBL Contraceptive Prevalence Rate (Text, Custom) Value Sogd: 30.7%; Khatlon: 22.9%, RRS 22.3% Sogd: 35%; Khatlon: 27%, RRS: 27% Date 31-Dec-2012 27-Mar-2017 20-Oct-2017 31-Dec-2019 Demographic and Health Survey (2012) was used to establish the baseline. Data from next DHS to measure progress will become available around September 2018. Routine project data is also unavailable at this point because necessary input data would be entered in the Performance-Based Financing information system by the end of 2017 calendar year. PHINDPDOTBL Average Health Facility Quality of Care Score (Text, Custom) Value 180 (Spitamen pre-pilot Rural Health Center - RHC) 91 (Spitamen Health Houses HH ) 251 (average among 10 participating districts, RHCs) 157 (average among 10 participating districts, HHs) 921 (average among 10 participating districts, RHCs) 395 (average among 10 participating districts, HHs) 250 for RHCs, 150 for HHs Date 15-Feb-2015 31-Dec-2016 20-Oct-2017 31-Dec-2019 These are data for the 2nd quarter of 2017. Based on the revised Performance-Based Financing Manual, the maximum possible scores for Rural Health Centers (RHC) and Health Houses (HH) are higher than in the original Manual, at 1,253 and 583, respectively. Therefore, the values attained, when converted to percentages terms for consistency, are at 74% for RHCs and 68% for HHs. 11/20/2017 Page 3 of 10
PHINDPDOTBL Percentage of children under-five with diarrhea treated with any Oral Rehydration Therapy (Text, Custom) Value Sogd: 79.2%; Khatlon: 68.2%, RRS 82.2% Sogd: 85%; Khatlon: 74%, RRS 85% Date 31-Dec-2012 27-Mar-2017 20-Oct-2017 31-Dec-2019 Demographic and Health Survey (2012) was used to establish the baseline. Data from next DHS to measure progress will become available around September 2018. Routine project data is also unavailable at this point because necessary input data would be entered in the Performance-Based Financing information system by the end of 2017 calendar year. Overall DHS (2012) was used to establish the baseline for PDO indicators 1, 2, 4. Data from next DHS to measure progress will become available around September 2018. Routine project data is also unavailable at this point because necessary input data would be entered in the PBF information system by the end of 2017 calendar year. Intermediate Results Indicators Number of eligible health facilities in which PBF is initiated (Number, Custom) Value 0.00 449.00 449.00 413.00 Indicator was achieved in 2016. 11/20/2017 Page 4 of 10
Percentage of Primary Health Care facilities eligible for PBF payments who received timely PBF payments in the preceding quarter (Percentage, Custom) Value 0.00 100.00 100.00 100.00 Based on the data for first 6 months of 2017. Number of independent verification visits completed per schedule (Number, Custom) Value 0.00 5.00 6.00 9.00 Based on the data for first 6 months of 2017. 11/20/2017 Page 5 of 10
Percentage of hypertensive adults who are currently receiving anti-hypertensive treatment (Text, Custom) Value 37.60 30.00 Data from IE end-line household survey will become available in Year 5 of the project. Percentage of hypertension patient charts with treatment according to protocol (Text, Custom) Value Sogd 59%, Khatlon 78%, RRS 39%, Combined 59% Sogd: 96%; Khatlon: 48%; Fayzabad: 94%; Combined: 67%. 60% Date 15-Aug-2015 27-Mar-2017 20-Oct-2017 31-Dec-2019 These are data for the 2nd quarter of 2017. Formally, the combined current value of the indicator has exceeded the target value. However, the value for Khatlon is low, mainly due to the rayons with decreases in indicator values: Yavan with 15%, Dangara with 30%, and Balkhi with 23%. In the Yavan rayon (lowest at 15%), the value of the quality indicator (section 4.2 on hypertension treatment) is low, mainly due to the subsection 4.2.3 - standard study of laboratory data, which averages at 8% for RHCs in the 2nd quarter. Number of mothers counselled on nutrition (Number, Custom) Value 0.00 97,036.00 106,658.00 3,000.00 Date 30-Mar-2015 27-Mar-2017 20-Oct-2017 31-Dec-2019 Based on the data for first 6 months of 2017. 11/20/2017 Page 6 of 10
Number of citizen scorecard exercises/sessions conducted in the project districts. (Number, Custom) Value 0.00 144.00 216.00 232.00 Date 13-Mar-2015 27-Mar-2017 20-Oct-2017 31-Dec-2019 Number of PHC facilities that developed and implemented action plans as a result of citizen feedback (Number, Custom) Value 0.00 58.00 72.00 72.00 Date 13-Mar-2015 27-Mar-2017 20-Oct-2017 31-Dec-2019 Indicator has been achieved. Health personnel receiving training (number) (Number, Custom) Value 0.00 5,463.00 8,193.00 7,957.00 Cumulative data including 9 months of 2017. 11/20/2017 Page 7 of 10
Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Value 0.00 102.00 102.00 388.00 No facility constructions completed and no additional facilities equipped since the previous visit. Number of project districts in which PBF MIS is operational (Number, Custom) Value 0.00 8.00 10.00 10.00 Indicator has been achieved. 11/20/2017 Page 8 of 10
Report on evaluation of pilot experience completed and action plan for the roll-out prepared (Yes/No, Custom) Value N Y Y Y Overall Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P126130 IDA-56660 Effective USD 5.50 5.50 0.00 1.16 4.44 21% P126130 IDA-D0700 Effective USD 4.50 4.50 0.00 1.14 3.51 25% P126130 IDA-H8790 Effective USD 15.00 15.00 0.00 10.66 3.43 71% P126130 TF-14871 Effective USD 4.80 4.80 0.00 2.63 2.17 55% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P126130 IDA-56660 Effective 22-Jun-2015 07-Aug-2015 04-Dec-2015 31-Dec-2019 31-Dec-2019 P126130 IDA-D0700 Effective 22-Jun-2015 07-Aug-2015 04-Dec-2015 31-Dec-2019 31-Dec-2019 P126130 IDA-H8790 Effective 30-Jul-2013 20-Sep-2013 11-Dec-2013 31-Jan-2019 31-Dec-2019 P126130 TF-14871 Effective 20-Sep-2013 20-Sep-2013 11-Dec-2013 31-Jan-2019 31-Jan-2019 Cumulative Disbursements 11/20/2017 Page 9 of 10
Restructuring History There has been no restructuring to date. Related Project(s) P153975-Additional Financing to TJ Health Services Improvement Project 11/20/2017 Page 10 of 10