The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) WESTERN AND CENTRAL AFRICA | Central African Republic | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2022 | Seq No: 4 | ARCHIVED on 27-Feb-2024 | ISR58776 | Implementing Agencies: Central African Republic, Ministry of Finance and Budget, Ministry of Health and Population, Central African Republic Key Dates Key Project Dates Bank Approval Date: 03-Jun-2022 Effectiveness Date: 15-Sep-2022 Planned Mid Term Review Date: 31-Dec-2024 Actual Mid-Term Review Date: Original Closing Date: 30-Sep-2027 Revised Closing Date: 30-Sep-2027 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase utilization of quality essential health services, especially for women and children, in targeted areas in the Central African Republic. 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) To increase utilization of quality essential health services, especially for women and children in targeted areas, and to protect essential social services for the population of CAR. Components Table Name Component 1: Supporting Essential Health Service Delivery:(Cost $28.00 M) Component 2: Strengthening Health System Performance and Preparedness:(Cost $19.20 M) Component 3: Project Management, Coordination and Monitoring & Evaluation (M&E):(Cost $2.80 M) Component 4: Contingent Emergency Response Component (CERC) Component 5: Payment of salaries and wages of social sector civil servants:(Cost $20.00 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 High High Implementation Status and Key Decisions The project development objective is to increase utilization of quality essential health services, especially for women and children, in targeted areas in the Central African Republic. 2/27/2024 Page 1 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) The project has progressed well with major contracts signed and teams in place after 15 months of project effectiveness. In October 2023, funds were allocated for payment of civil servants in the social sector to the Government of CAR as an emergency measure to bridge the fiscal gap. There had been a lack of availability of credible data, this issue is being addressed with the start of verification for performance-based financing. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic Substantial High High Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial High High Results PDO Indicators by Objectives / Outcomes Supporting Essential Health Service Delivery IN01368055 ►Children who have received 3 doses of Pentavalent vaccine (Penta3) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 43,059.00 47,507.00 94,991.00 58,120.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Source: PBF data Number of children who have received third doses of Pentavalent vaccine from staff of facilities targeted by the Project. As verification of reported PBF data for Q4 2023 is still ongoing, the reported actuals are Comments: based on an estimate derived from the previous 3 quarters where verified data is available (Q1-Q3 2023). Final data will be available as of March 2024. Deviation from previous reporting are due to: (i) the fact that last reporting had to use SNIS data; and (ii) takes into account the result of a nationwide mass vaccination campaign that took place in Q4. 2/27/2024 Page 2 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) This indicator is non-cumulative and targets are yearly targets. Baseline represents annual data of 2021. IN01368102 ►Deliveries attended by skilled health personnel (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 82,373.00 87,119.00 76,615.00 90,060.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Number of deliveries attended by skilled health personnel in facilities (including facility based dutocic deliveries, dystocic deliveries and c-sections) targeted by the project. As verification of reported PBF data for Q4 2023 is still ongoing, the reported actuals are based on an estimate derived from the previous 3 quarters where verified data is available (Q1-Q3 2023). Final data Comments: will be available as of March 2024. Deviation from previous reporting is most likely due to overreporting of the previous data from HMIS. This indicator is non-cumulative and targets are yearly targets. Baseline represents annual data of 2021. IN01368103 ►Modern contraceptive services received by women and adolescents (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 104,053.00 96,702.00 115,284.00 125,128.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Number of contraceptive services (oral contraceptives, injections, intrauterine devices and implants) delivered in the previous 4 quarters where data available in facilities targeted by the Project. As verification of reported PBF data for Q4 2023 is still ongoing, the reported actuals are based on an estimate derived from the previous 3 quarters where verified data is available (Q1-Q3 2023). Final data Comments: will be available as of March 2024. Actuals for previous reporting for long-term and permanent had entry errors. This indicator is non-cumulative and targets are yearly targets. Baseline represents annual data of 2021. IN01368104 Modern contraceptive services received by women and adolescents – short-term (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 102,112.00 94,381.00 112,017.00 111,640.00 Date 01-Mar-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 IN01368105 Modern contraceptive services received by women and adolescents – long-term and permanent (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1,941.00 94,381.00 3,268.00 13,518.00 Date 01-Mar-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 IN01368106 ►Availability of tracer drugs at health centers in targeted districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 2/27/2024 Page 3 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) Value 76.00 85.00 81.00 85.00 Date 01-Feb-2022 31-Jan-2023 31-Mar-2023 30-Sep-2027 Average of the percentage of tracer drugs (as defined in the PBF quality assurance tool) available in each health centre for the previous 4 quarters where data available in facilities targeted by the Project. Comments: Updated not available after Q1 2023. The actual value represents only Q1 2023, will be updated once data obtained. IN01368107 ►Average quality score of health centers in targeted districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 55.00 56.00 57.00 80.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Average of PBF quality scores for the previous four quarters where data available in facilities targeted by the Project. As verification of reported PBF data for Q4 2023 is still ongoing, the reported actuals are based on an estimate derived from the previous 3 quarters where verified data is available (Q1-Q3 2023). Comments: Final data will be available as of March 2024. Quality of data for this indicator remains questionable and measures to improve the data and assessment process are being implemented. Protecting essential social services IN01368101 ►Eligible civil servants who received previous months’ salary in-full and on time (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 95.00 Date 16-Jun-2023 16-Jun-2023 16-Jun-2023 31-Dec-2024 Intermediate Results Indicators by Components 1. SUPPORTING ESSENTIAL HEALTH SERVICE DELIVERY IN01368115 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 734,020.00 1,219,720.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Baseline revised to 0 to fully align with CRI definition (to be formally revised as part of the AF). As verification of reported PBF data for Q4 2023 is still ongoing, the reported actuals are based on an Comments: estimate derived from the previous 3 quarters where verified data is available (Q1-Q3 2023). Final data will be available as of March 2024. IN01368118 2/27/2024 Page 4 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 497,542.00 821,720.00 IN01368120 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 244,872.00 434,650.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 IN01368122 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 242,427.00 350,620.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 IN01368123 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 246,721.00 434,450.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 1.1: Increasing Health Service Utilization and Quality through PBF IN01368108 ►Pregnant women who have attended 4 antenatal care visits (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 38,907.00 44,468.00 116,785.00 66,710.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Number of pregnant women who have attended a fourth antenatal care visit in facilities targeted by the Project. As verification of reported PBF data for Q4 2023 is still ongoing, the reported actuals are based on an estimate derived from the previous 3 quarters where verified data is available (Q1-Q3 2023). Comments: Final data will be available as of March 2024. This indicator is non-cumulative and targets are yearly targets. Baseline represents annual data of 2021. IN01368116 ►Patients under the Free Health Services (Gratuité Ciblé) scheme who report receiving their service and medication at no charge (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 81.00 81.00 53.00 90.00 2/27/2024 Page 5 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Percentage of eligible patients in the PBF community survey who report not having paid any charges for services or medication. Actuals based only on Q4 2024. In all the regions covered by the project, health facility exit surveys began Comments: in Q4 2024, so we do not have enough data to estimate the value of the first three quarters. This indicator will be reassessed when subsequent four quarters become available. IN01368119 ►Facilities receiving performance payments on time (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 60.00 63.00 80.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Percentage of facilities eligible for performance payments that received them in accordance with the timelines set out in the PBF Manual. All health facilities paid in cash did not receive their subsidy on Comments: time given the payment channel, and during the year health facilities that have an account with the CBA experienced delays in payment from the third quarter onwards. IN01368121 ►Quality satisfaction score of beneficiaries for health services in district hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 56.00 40.00 80.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Last available data is only from Q4 2023. This indicator suffered from lack of quality evaluation. The Q4 data is based on exit survey carried out in health region 2 on a sample of patients to construct the Comments: satisfaction indicator from the data available. To be updated once quality assessment is fully in place. 1.2 Strengthening community-based essential health service delivery IN01368109 ►People referred to health facilities by community workers (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 76,496.00 73,150.00 14,696.00 97,550.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Number of patient referrals by community health workers to facilities (with proof of receipt at the facility) targeted by the Project. The actuals data is from HMIS and quality needs to be questioned, we will reassess once PBF data becomes available. Comments: This indicator is non-cumulative and targets are yearly targets. Baseline represents annual data of 2021. 1.3: Providing Holistic Support to GBV Survivors 2/27/2024 Page 6 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) IN01368112 ►District hospitals with integrated GBV services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 5.00 10.00 15.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Number of hospitals supported by the Project that have a psychosocial agent and staff trained in GBV Comments: services. Activities have started in all 10 target districts. 2. STRENGTHENING HEALTH SYSTEM PERFORMANCE AND PREPAREDNESS IN01368114 ►NHDP/Investment Case performance reports discussed at quarterly meetings of the Comite de Pilotage Unique (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 15.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2023 30-Sep-2027 Cumulative number of quarters in which PNDS and/or Investment Case performance reports were Comments: presented and discussed at a meeting of the country platform (Comité de Pilotage Unique). 2.2: Upgrading Hospitals to Improve Domestic Diagnostic and Treatment Capacity IN01368111 ►Number of hospitals scoring 80% or higher on the 'diagnostic capacity' components of the PBF quality assurance checklist (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 12.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Number of hospitals scoring an average of 80% or higher for the new 'diagnostic capacity' sub-score of the PBF quality checklist for hospitals. Data not yet available as quality assessment didn't take place in Comments: most of the hospitals. This indicator will be revised as part of the AF. 2.3: Implementation Support for Key Health Sector Reforms IN01368113 ►Number of additional health professionals employed full-time in health facilities in targeted districts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 274.00 326.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2024 30-Sep-2027 Number of health professionals employed in facilities targeted by the Project as reported in the latest Comments: quarterly PBF submissions. The team proposes to drop the initial wording "additional" as this is not tracked in the PBF data. This will be formally revised as part of the AF. 2/27/2024 Page 7 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) Data based on health professionals who are trained/deployed under the project. Gender disaggregation not yet available (in the process of obtaining data). IN01368117 Number of health professionals employed full-time in health facilities in targeted districts - female (disaggregation) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 190.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2023 30-Sep-2027 2.4: Integrating Pandemic Preparedness in Health System Strengthening IN01368110 ►CHWs trained on epidemic surveillance and preparedness (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1,650.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2023 30-Sep-2027 Cumulative number of community health workers (CHWs) trained on epidemic surveillance and preparedness with support from the project in targeted districts. Comments: No data available. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P177003 IDA-E0480 Effective USD 58.00 58.00 0.00 22.64 32.93 41% P177003 TF-B8319 Effective USD 12.00 12.00 0.00 2.06 9.94 17% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P177003 IDA-E0480 Effective 03-Jun-2022 28-Jun-2022 15-Sep-2022 30-Sep-2027 30-Sep-2027 P177003 TF-B8319 Effective 03-Jun-2022 28-Jun-2022 15-Sep-2022 30-Jun-2025 30-Jun-2025 Cumulative Disbursements 2/27/2024 Page 8 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) Restructuring History Level 2 Approved on 12-Oct-2023 Related Project(s) P181561-Additional Financing- CAR Health Service Delivery and System Strengthening Project 2/27/2024 Page 9 of 9