Public Disclosure Authorized AFRICA Swaziland Health, Nutrition & Population Global Practice IBRD/IDA Specific Investment Loan FY 2011 Seq No: 12 ARCHIVED on 29-Jun-2017 ISR28124 Implementing Agencies: Ministry of Health, Ministry of Finance, Deputy Prime Minister's Office Public Disclosure Authorized Key Dates Key Project Dates Bank Approval Date:10-Mar-2011 Planned Mid Term Review Date:30-Apr-2015 Original Closing Date:31-May-2016 Project Development Objectives Effectiveness Date:09-May-2012 Actual Mid-Term Review Date:24-Oct-2014 Revised Closing Date:31-Mar-2018 Public Disclosure Authorized Project Development Objective (from Project Appraisal Document) The project development objectives (PDOs) are: (i) to improve access to and quality of health services in Swaziland with a particular focus on primary health care, maternal health and TB, and (ii) to increase social safety net access for OVC. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Strengthening the Capacity of the Health Sector:(Cost $3.90 M) Public Disclosure Authorized Facility-level Support to Improve Access, Quality and Efficiency of Services:(Cost $24.38 M) Strengthening of the Orphans and Vulnerable Children (OVC) Safety Net:(Cost $6.71 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions 6/29/2017 Page 1 of 10
The project s closing date was extended to March 31, 2018. To date, 67 percent of the consolidated World Bank loan (US$ 20 million) and European Union grant (14.5 million Euros) funds have disbursed. Highlights of recent progress include: (i) accelerated progress on the Health Financing Technical Assistance, including completion of Phase I which identified reform areas that would improve the effectiveness, efficiency, and equity of the health care system and initialization of Phase II which operationalizes the agreed priorities for reform; (ii) Completed renovations at the Mbabane Government Hospital maternity ward, Good Shepherd School of Nursing, Mkhuzweni Health Center maternity ward, and Maternity Waiting Homes at Good Shepherd and RFM Hospitals, and continued progress of renovations at three health centers (Nhlangano, Matsanjeni and Dvokolwako), four health clinics (Mangweni, Ikhwezi, Dwalile and Lavumisa clinics) and the TB Centre in Manzini; (iii) Provision of the fourth payment of the OVC Cash Transfer Pilot as of March 2017 reaching 7,063 beneficiaries, and enrollment of additional 11,000 beneficiaries as of March 2017. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- Moderate Moderate Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Substantial Substantial Fiduciary -- Substantial Substantial Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial Substantial Results Project Development Objective Indicators PHINDPDOTBL Health facilities that provide at least five public health services: (i) family planning (modern methods);(ii) postnatal care, (iii) management of STI/HIV, (iv)immunization; and (iv) growth monitoring (Percentage, Custom) Value 56.30 68.30 68.30 75.00 Date 31-Dec-2010 20-Dec-2016 28-Apr-2017 31-Mar-2018 Source: HMIS - MOH, Strategic Information Department (SID) Actual (Apr 2017) - 155 out of 227 facilities. The 227 denominator comes from the 2013 Service Availability Mapping (SAM) 6/29/2017 Page 2 of 10
report for health facilities providing family health services. The denominator used in the PAD was 223 which was from the 2010 SAM report. PHINDPDOTBL Caesarean deliveries as a percentage of institutional deliveries at health facilities (Percentage, Custom) Value 10.15 11.89 13.16 12.00 Date 31-Dec-2011 20-Dec-2016 28-Apr-2017 31-Mar-2018 This indicator was added as part of the May 2016 level II restructuring. Source: HMIS 2015: 13.27% (3090/23,277) 2016: 11.45% (2895/25,274) Actual figure (Dec 2016) of 11.89% reflects available cumulative data from 2012 Sept 2016, i.e. third quarter of 2016 Actual (Apr 2017) - 15,729/119,490, i.e. 13.16% (cumulative figures from 2012 2017) PHINDPDOTBL TB treatment success rate among bacteriologically confirmed cases (Percentage, Custom) Value 71.00 80.70 80.46 85.00 Date 31-Dec-2011 31-Dec-2015 28-Apr-2017 31-Mar-2018 Source: National TB Control Programme 2012: 1356/1857 2013: 2031/2649 2014: 2197/2540 2015: 2089/2568 2016: 2061/2484 Actual (Dec 2016) - 9734/12,098, i.e. 80.46% - Cumulative data from 2012 to December 2016 6/29/2017 Page 3 of 10
PHINDPDOTBL OVC beneficiaries that receive cash transfers quarterly (as defined in the Implementation Manual) (Percentage, Custom) Value 0.00 88.30 88.30 75.00 Date 01-Jan-2011 20-Dec-2016 28-Apr-2017 31-Mar-2018 Source: Project records Actual (June 2016) - 5518 beneficiaries out of targeted 8000, i.e. 68.98% Actual (Dec 2016) - 7063 out of targeted 8000 beneficiaries, i.e. 88.3% Overall Intermediate Results Indicators Nurses or midwives enrolled at nursing training institutions supported by the project (Number, Custom) Value 581.00 924.00 1,959.00 1,442.00 Date 31-Dec-2011 20-Dec-2016 28-Apr-2017 31-Mar-2018 Source: Project Records This indicator is now reported cumulatively. 2011: 581; 2012: 267; 2013: 239; 2014: 246; 2015: 268; 2016: 358; Revised End target: Revised cumulative end target of 1442 following the June 2017 restructuring incorporates the former annual end target of 518 nurses/midwives expected to be enrolled between 2017-2018 in addition to the 924 students already enrolled as of Dec 2016, i.e. (924 + 518 = 1442). 6/29/2017 Page 4 of 10
PHINDIRITBL Pregnant women receiving antenatal care during a visit to a health provider (number) (Number, Custom) Value 13,963.00 30,751.00 107,863.00 132,186.00 Date 31-Dec-2012 10-Jun-2016 28-Apr-2017 31-Mar-2018 Source: HMIS This indicator is now reported cumulatively. 2013: 29,466 2014: 28,913 2015: 27,454 2016: 22,030 Actual (Dec 2016) figure of 107,863 reflects cumulative figure from Jan 2014-Sept 2016 No new data was received for the first quarter of 2017 Revised end target: Revised cumulative end target of 132,186 as of the June 2017 restructuring incorporates the former annual end target of 24,323 pregnant women receiving ANC between 2017-2018 in addition to the 107,863 having already received ANC as of Dec 2016, i.e. 107,863 + 24,323 = 132,186. People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Value 25,400.00 129,213.00 119,490.00 153,703.00 Date 31-Dec-2011 20-Dec-2016 28-Apr-2017 31-Mar-2018 This is the composite HNP GP CRI included as part of the level II restructuring in June 2017. The comments below are related to the sub-indicator for the composite CRI. This indicator is now reported cumulatively. 2012: 23,714 2013: 23,867 2014: 23,358 2015: 23,277 2016: 25,274 Actual (Apr 2017) figure of 119,490 reflects cumulative data from 2012-2016 Data source of this indicator was changed from HMIS to hospital records which is considered more reliable, resulting in a decline in the cumulative figure from 129,213 in Dec 2016 to 119,490 in Apr 2017. Revised end target: Revised cumulative end target of 153,703 following the June 2017 restructuring incorporates the former 6/29/2017 Page 5 of 10
PHINDIRITBL annual end target of 24,490 expected facility deliveries between 2017-2018 in addition to the 129,213 facility deliveries as of Dec 2016, i.e. 129,213 + 24,490 = 153,703. Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Value 25,400.00 129,213.00 119,490.00 153,703.00 Date 31-Dec-2011 20-Dec-2016 28-Apr-2017 31-Mar-2018 People receiving tuberculosis treatment in accordance with the WHO-recommended Directly Observed Treatment Strategy (DOTS) (number) (Number, Custom) Value 9,180.00 4,567.00 3,806.00 6,100.00 Date 31-Dec-2011 31-Dec-2015 28-Apr-2017 31-Mar-2018 Source: National TB Control Programme This indicator was inadvertently reported as cumulative in the Dec 2016 ISR but the level II restructuring reflected that it will now be reported on annually 2012: 7,741 2013: 6,665 2014: 5582 2015: 4567 2016: 3806 Actual (Apr 2017) - This indicator is reported annually. The figure for April 2017 comprises the complete data from Jan-Dec 2016 which was recently collated. End target: While the end target was maintained at 6100, it should be noted that TB case notification has been gradually declining over the years at a rate of 16% per annum and this has further been validated by the decrease in TB prevalence and incidence rates as outlined in the 2016 global TB report. This will impact the performance of this indicator and as the reducing number of case notifications impacts the numbers of those treated according to DOTS. 6/29/2017 Page 6 of 10
PHINDIRITBL Health personnel receiving training (number) (Number, Custom) Value 22.00 295.00 1,085.00 1,150.00 Date 31-Dec-2012 31-Mar-2016 28-Apr-2017 31-Mar-2018 Source: Project records This indicator is now reported cumulatively. 2012: 22 2013: 99 2014: 352 2015: 275 2016: 337 Actual (Apr 2017) figure of 1085 reflects the cumulative number of health professionals trained between 2012 to date. End target: The revised cumulative end target of 1150 as of the June 2017 restructuring incorporates the former annual end target of 65 expected health professionals to be trained between 2017-2018 in addition to the 1085 health professionals already trained as of Dec 2016, i.e. 1085 + 65 = 1150. HIV Positive TB Patients (adults and children) who are initiated on antiretroviral therapy (Percentage, Custom) Value 50.70 92.10 92.40 90.00 Date 31-Dec-2011 20-Dec-2016 28-Apr-2017 31-Mar-2018 Source: National TB Control Programme 2012: 3749/5667 (66.2%) 2013: 3544/4747 (74.7%) 2014: 3123/3972 (78.6%) 2015: 3151/3401 (92.6%) 2016: 2449/2649 (92.4% Jan-Dec 2016) Actual (Apr 2017): This indicator is reported as an annual figure for Jan-Dec 2016. 6/29/2017 Page 7 of 10
PHINDIRITBL PHINDIRITBL Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Value 0.00 12.00 12.00 15.00 Date 01-Jan-2011 20-Dec-2016 28-Apr-2017 31-Mar-2018 OVC directly supported through this cash transfer pilot (Number, Custom) Value 0.00 7,063.00 7,063.00 8,000.00 Date 01-Jan-2011 20-Dec-2016 28-Apr-2017 31-Mar-2018 Source: Project records Actual (June 2016) - 5518 beneficiaries out of targeted 8000 Actual (Dec 2016) - 7063 out of targeted 8000 beneficiaries Generation of quarterly payment lists to support regular and predictable cash transfers to beneficiaries (Yes/No, Custom) Value N N N Y Date 22-Jun-2017 22-Jun-2017 22-Jun-2017 31-Mar-2018 Source: Project Records This is a new indicator introduced as part of the June 2017 restructuring 6/29/2017 Page 8 of 10
Percentage of grievance and redress cases resolved in 45 days of its receipt/registration into the MIS system (Percentage, Custom) Value 50.00 50.00 50.00 75.00 Date 22-Jun-2017 22-Jun-2017 22-Jun-2017 31-Mar-2018 Source: Project records This is a new indicator introduced as part of the June 2017 restructuring. Overall This Results Framework reflects the following changes made to the Intermediate Outcome level indicators in the June 2017 level II restructuring: i. Four intermediate outcome (IO) indicators now report cumulatively instead of annually in order to better capture trends over the lifespan of the project: (i) Nurses or Midwives enrolled at nursing training institutions supported by the project; (ii) Pregnant women receiving antenatal care during a visit to a health provider; (iii) Number of deliveries at health facilities (replaced by the CRI sub-indicator: number of deliveries attended by skilled health personnel ); and (iv) Health personnel receiving training. The current annual targets of these indicators as of the project closing date on 31st March, 2018 have been converted to cumulative targets. ii. The IO indicator, People receiving tuberculosis treatment in accordance with the WHO-recommended Directly Observed Treatment Strategy (DOTS), is maintained as an annually reported and targeted indicator, with an end target of 6,100 patients treated for TB in accordance with DOTS in the final year of the project. This indicator was inadvertently reported as cumulative in the December ISR. iii. Two new intermediate indicators were introduced as better measures of the progress achieved in administering the cash transfer program: (i) Generation of quarterly payment lists to support regular and predictable cash transfers to beneficiaries; and (ii) Percentage of grievance and redress cases resolved in 45 days of its receipt/registration into the MIS system. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P110156 IBRD-80190 Effective USD 20.00 20.00 0.00 12.98 7.02 65% P110156 TF-11740 Effective USD 12.01 12.01 0.00 12.01 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P110156 IBRD-80190 Effective 10-Mar-2011 14-Dec-2011 09-May-2012 31-May-2016 31-Mar-2018 6/29/2017 Page 9 of 10
P110156 TF-11740 Effective 04-Apr-2012 04-Apr-2012 09-May-2012 31-May-2016 31-Mar-2018 Cumulative Disbursements Restructuring History Level 2 Approved on 26-May-2016,Level 2 Approved on 27-Sep-2016,Level 2 Approved on 27-Jun-2017 Related Project(s) There are no related projects. 6/29/2017 Page 10 of 10