FOR OFFICIAL USE ONLY Report No: RES50186 INTERNATIONAL DEVELOPMENT ASSOCIATION RESTRUCTURING PAPER ON A PROPOSED PROGRAM RESTRUCTURING OF MOZAMBIQUE PRIMARY HEALTH CARE STRENGTHENING PROGRAM APPROVED ON DECEMBER 20, 2017 TO THE REPUBLIC OF MOZAMBIQUE Health, Nutrition & Population Global Practice Eastern and Southern Africa Region Regional Vice President: Victoria Kwakwa Country Director: Idah Z. Pswarayi-Riddihough Regional Director: Daniel Dulitzky Practice Manager: Ernest E. Massiah Task Team Leaders: Humberto Albino Cossa, The World Bank Mozambique Primary Health Care Strengthening Program (P163541) ABBREVIATIONS AND ACRONYMS AA Administration Agreement APE Community Health Worker (Agente Polivalente Elementar) CMAM Centre of Medicines and Medical Supplies DLI Disbursement-linked Indicator DLR Disbursement-linked Result DNAM National Directorate of Medical Services DNSP National Directorate of Public Health (Direcção Nacional de Saúde Pública) DSA Department of Environmental Health DPC Directorate of Planning and Cooperation (Direcção de Planificação e Cooperação) FM Financial Management FCDO UK Foreign, Commonwealth and Development Office FY Fiscal Year GFF Global Financing Facility GRM Grievance Redress Mechanism HNP Health, Nutrition, and Population IC Investment Case IDA International Development Association IP Implementation Progress IPF Investment Project Financing MISAU Ministry of Health (Ministério de Saúde) PAP Program Action Plan PBA Performance-based Allocations PDO Program Development Objective PES Economic and Social Plan (Plano Económico Social) PforR Program-for-Results PMU Program Management Unit POM Program Operational Manual RMNCAH-N Reproductive, Maternal, Neonatal, Child and Adolescent Health and Nutrition SDTF Single Donor Trust Fund SISMA Health Information System for Monitoring and Evaluation (Sistema de Informação de Saúde para Monitoria e Avaliação) ToR Terms of Reference The World Bank Mozambique Primary Health Care Strengthening Program (P163541) USAID United States Agency for International Development The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DATA SHEET (Mozambique Primary Health Care Strengthening Program - P163541) BASIC DATA Project ID Financing Instrument IPF Component P163541 Program-for-Results Financing No Approval Date Current Closing Date 20-Dec-2017 31-Dec-2023 Organizations Borrower Responsible Agency Ministry of Economy and Finance Program Development Objective(s) The Program Development Objective is to improve the utilization and quality of reproductive, maternal, child and adolescent health and nutrition services, particularly in underserved areas. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Approval Effectiveness Closing Ln/Cr/TF Signing Date Commitment Disbursed Undisbursed Date Date Date IDA-D2650 20-Dec-2017 02-Mar-2018 18-Apr-2018 31-Dec-2023 80.00 70.90 7.81 21-May- TF-B4481 21-May-2021 21-May-2021 31-Dec-2023 3.00 2.44 .56 2021 TF-B3368 01-Oct-2020 16-Oct-2020 16-Oct-2020 31-Dec-2023 7.00 6.27 .73 TF-A9398 28-Feb-2019 21-Mar-2019 21-Mar-2019 31-Dec-2023 44.95 41.02 3.93 TF-A6152 20-Dec-2017 02-Mar-2018 18-Apr-2018 31-Dec-2023 25.00 16.85 8.15 Policy Waiver(s) Does the Program require any waivers of Bank policies applicable to Program-for-Results operations? No Page 1 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) The World Bank Mozambique Primary Health Care Strengthening Program (P163541) I. PROGRAM STATUS AND RATIONALE FOR RESTRUCTURING A. Program Status 1. The Mozambique Primary Heath Care Strengthening Program (P163541, “the Program”) was approved on December 20, 2017, and closes December 31, 2023. Following the signing of the legal agreements on February 12, 2018 (IDA grant D265-MZ of US$80 million equivalent and Global Financing Facility – GFF grant TF0A6152-MZ of US$25 million), the Program was declared effective on April 18, 2018. The program aims to improve the utilization and quality of reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH-N) services, particularly in underserved areas. The Program is co-financed by the United Kingdom’s Foreign, Commonwealth and Development Office (FCDO; a single-donor trust fund, SDTF, of approximately US$11 million), the United States Agency for International Development (USAID; an SDTF of US$7 million), and a multi-donor trust fund (MDTF) contributed by the Global Affairs Canada (US$57 million) and the Netherlands (US$36 million) in addition to the IDA, GFF and the Government of Mozambique (GoM)1. Disbursements stand at US$137.59M out of US$200.77M (remaining to be disbursed US$63.18M). The Program supports Mozambique’s Investment Case (IC) to mobilize and align financing for high-impact investments in RMNCAH-N services and health systems. It has made critical contributions to achieve key results, particularly in the context of COVID-19 in which essential health services have been strained. Progress toward achieving the Program Development Objective (PDO) and Implementation Progress were both rated Moderately Satisfactory in the last Implementation Status and Results Report (ISR) of July 9, 2022. 2. Despite the continued challenges associated with COVID-19, the Program has contributed to important results of the sector in a range of critical areas, as highlighted by key DLI achievements. There was strong progress in the first two years of the Program, with most targets achieved. In 2021, the number of lagging districts that reached the target of 85 percent institutional deliveries increased from 28 in 2019 to 32 out of 42 (with an increase in the district average from 71 to 88 percent)[FY2020]; couple years of protection increased from 1,722,692 in 2017 to 3,246,552,; the number of active Community Health Workers (Agentes Polivalentes Elementares - APE) more than doubled from the start of the Program, from 3,380 to 7,179; clinical staff at primary care facilities increased by 25 percent; and the share of domestic resources spent on the health sector increased from 7.8 (average from 2014-2016) to 9.6[FY2020]. Facility scorecards and performance-based allocations have been rolled out in 34 district and rural hospitals and 298 health centers in high impact districts as identified in the IC, where civil society is implementing complementary community scorecards to engage citizens in service delivery with financing from the Ministry of Health (MISAU). Main programmatic challenges include: (i) lack of documentation to validate the reported expansion of the sexual and reproductive health package in secondary and technical schools in 2020, and delayed approval of training materials and guidelines in 2021 (DLI 2); (ii) slower than desired expansion of the nutrition intervention package (DLI 4), due to delayed training and global supply chain disruptions, to be accelerated through the hiring of NGOs by MISAU in 2022;  (iii) lower than expected domestic expenditures for health (DLI 5), comprising 8.8% of total expenditures in 2021 vs. the target of 9.5%, and down from 9.6% in 2020, due in part to limited liquidation of allocated funds by the Ministry of Economy and Finance (MEF); and (iv) limited capacity to develop and implement significant reforms to improve the quality of APEs (DLI 10). DLI 12 validation continues to be delayed, as the National Health Institute sent a version of the analysis which still requires revision to align with the agreed protocol. 1These amounts include contributions to Bank-Executed Trust Funds for Program implementation support and complementary advisory services and analytics. The World Bank Mozambique Primary Health Care Strengthening Program (P163541) B. Rationale for Restructuring 3. The proposed restructuring responds to the GoM’s request dated December 27, 2022, to adjust the DLI matrix to the Program’s reduced financing envelope, and to mitigate limited progress also linked to COVID-19 effects. The reduction comes from two sources: FCDO and USAID. FCDO’s co-financing was integrated into the Program based on a letter of indicative commitment to finance the Program in the amount of GBP 25 million, as reflected in the approved Program Paper dated March 1, 2019. Precipitated by a global reduction in available financing the total envelope has now been reduced to GBP 8.8 million, channeled through SDTF 0B4481. USAID’s commitments to the Program were also incorporated using the basis of accounting of cash plus commitment, in the amount of US$22.5 million. In June 2021, USAID announced its exit from the Program in favor of bilateral assistance to the sector, after contributing US$7.4 million to the Program.2These reductions, totaling approximately US$36.5 million, constitute 32 percent of the remaining DLI allocation totals for 2021 to 2023. The 2021 allocation were included in these estimations as the validation process took a long period due to restrictions in travel within country during COVID-19, which forced the validation agency to carry out virtual reviews and consultations. The quality of data and lengthy interactions caused significant delays to complete the exercise, which was concluded recently. The revised total financing per source for the Program (including Bank-executed resources for complementary analytics and implementation support) is summarized in Table 1 below. Table 1. Status of Program Financing Source Previous Financing Envelope (US$ million equivalent) Revised Financing Envelope (US$ million equivalent) IDA 80.0 80.0 GFF 25.0 25.0 MDTF (Canada, Netherlands) 92.6 82.5 SDTF USAID 22.5 7.4 SDTF FCDO 33.1 6 Total 253.2 200.9 * Amounts indicate total commitments, not funds received. For the MDTF, US$44 million equivalent has been received, while US$8.8 million has been received from the FCDO. 2 This included US$6.3 million disbursed to the Government based on DLI achievements of the US$7 million committed in the grant agreement, from which the remaining US$733K was cancelled. Of USAID’s total contribution of US$7.4 million, US$1.2M was also used for Bank Executed Trust Funds (analytical work, technical assistance, and implementation support) and cost recovery of the recipient executed grant (US$350K). The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Table 2: Cumulative DLI disbursements DLI Total Allocated US$M Cumulative Disbursed US$M Undisbursed US$M 1 21.20 15.22 5.98 2 16.50 2.00 14.50 3 20.50 12.92 7.58 4 19.27 5.14 14.13 5 13.50 10.01 3.49 6 4.00 4.00 7 16.00 8.75 7.25 8 22.50 14.95 7.55 9 26.00 14.23 11.77 10 19.00 8.86 10.14 11 17.80 10.01 7.79 12 4.50 4.50 200.77 102.09 98.68 Advances 35.50 Total 200.77 137.59 63.18 II. DESCRIPTION OF PROPOSED CHANGES 4. This level II restructuring is proposed to include the following: (i) adjustments in the DLI matrix; (ii) changes in the results framework; (iii) revision of the disbursement estimates; and (iv) cancellation of US$733,333.20 under the USAID trust fund. 5. The DLI Matrix agreed with the Government is proposed to be adjusted to the new financing envelope, and based on an analysis of the progress and challenges to date, including the ongoing burdens of the COVID-19 response. No changes are proposed to the PDO or Program Action Plan. The proposed changes will apply to 10 of the 12 DLIs as follows: (i) the allocations for DLIs 1,8 and 9 are being reduced due to the reduction of overall resource envelope; (ii) DLIs 2, 4, 6, 7, 10, 11 and 12 have targets and allocations changed to account for both the resource envelope and the negative impact of COVID- 19 on school health activities, and community gatherings for training of community health workers, as well as challenges in the supply chain that impacted on the delivery of key commodities for nutrition. More specifically, the restructuring incorporates the following revisions: (i) removing 2023 DLRs (totaling $16.7 million, enabling sufficient time for DLI verification and Program closing by December 2023); (ii) eliminating some process indicators to streamline the DLI matrix; and (iii) adjusting select targets to ensure they are both challenging and feasible (DLI 2 on sexual and reproductive health services in schools, DLI 4 on the nutrition intervention package, DLI 6 on expenditures in disadvantaged provinces and districts, and the quality target for DLI 10 on APE services). Allocations to DLIs have been adjusted accounting for these scope revisions and past performance, with a reduction of US$22.53 million for 2018-2022 targets. Changes per DLI are summarized as follows: (i) DLI 1 (institutional deliveries) - The amount allocated to this DLI is reduced from US$22.2 million to US$21.2 million to cater for the reduced resource envelope. The World Bank Mozambique Primary Health Care Strengthening Program (P163541) (ii) DLI 2 (sexual and reproductive health [SRH] in secondary and technical schools) - The 2023 target is removed, the DLR “Completion of training for health providers using new training materials” for 2022 is revised to “Approval of updated training materials”, and the end (2022) target for secondary and technical schools offering SRH services is reduced from 60 percent to 50 percent. The amount allocated to this DLI is reduced from US$22.5 million to US$16.5 million. Changed due to no funds available and effects of COVID-19 on school attendance. During the same period, it was not possible to complete the revision of training material and complete subsequent training. The remaining time on the project is only sufficient to update training materials, actual training would not be achievable. (iii) DLI 3 (Couple Years Protection, CYP)3 - No change. There was good progress here. (iv) DLI 4 (Nutrition Intervention Package -NIP) – The 2023 targets are removed due to reduction of available funds, and the sub-target on the quality of nutrition sites is removed, namely “75 percent of nutrition sites meet minimum quality standards” for 2021, as key criteria for operationalizing the NIP can be measured through the verification of minimum criteria under the NIP coverage indicator4. This means that only children who receive the entire NIP package will be counted for the target set for 2021 and 2022. The Bank will still conduct analytical work on the quality and impact of NIP implementation to inform its roll-out. The 2021 and 2022 DLRs will be reduced from 40 percent to 30 percent of children benefitting from the NIP in the eight target provinces and 60 percent to 40 percent, respectively (which would still be a significant gain from the 4 percent achieved in 2020). The change of the 2021 target is a fait accompli, because the request for restructuring was prepared more than a year ago. The verification process for 2021 was finalized in December 2022. This is ambitious but can still be achieved with the engagement of non-governmental organizations (NGOs) to support implementation underway, and the strong commitment expressed by MISAU. The amount allocated to this DLI is reduced from US$24 million to US$19.25 million. (v) DLI 5 (domestic financing for health) - No change. Remained the same so the health spending would not be reduced. (vi) DLI 6 (equitable health financing) –The previous iteration of the DLI incentivized increasing cumulative provincial and district expenditures in the underserved provinces from the sub-account resources. It was not working well for a variety of reasons, including the complexities of the concurrent decentralization reforms, resulting challenges in flow of funds and accounting for in-kind support, and capacity for execution at provincial and district levels. The DLI will be refocused on Direct Support to Health Facilities (Apoio Direito as Unidades Sanitarias - ADUS), building on the progress achieved in introducing more direct forms of health facility financing through DLIs 8 and 9. Rather than being based on scorecard performance thresholds (as will DLIs 8 and 9), financing to facilities would be channeled in the form of block grants. The focus would be on facilities with internment in the three historically underserved provinces, which have been the focus of DLI 6 (Nampula, Zambezia, and Tete). For facilities already receiving payments through DLIs 8 and 9, the non-conditional payments would be additional. The proposed revised 2021 and 2022 targets are thus: “Signing of Program Contracts with eleven provinces” and “Grants disbursed for 100% of primary health care facilities with internment in the three underserved provinces”, respectively. These will help move funds to the front lines more quickly and directly. Support to further elaborate the mechanisms for this financing will be provided through technical assistance. The amount allocated to this DLI is reduced from US$13 million to US$4 million. 3 Couple Years of Protection is the estimated protection provided by family planning services during a one-year period, based upon the volume of modern contraceptives methods sold or distributed free of charge to users during that period. 4 The minimum standards refers to the delivery of a comprehensive package of interventions, namely: (i) counseling on exclusive breastfeeding from 0 to 6 months; ii) counseling on adequate and responsive complementary feeding, including on the timely and continuous consumption of MNP from 6 to 23 months; iii) deworming of children from 12 to 23 months; iv) counseling on improving practices in relation to drinking water, hygiene and sanitation; v) regular monitoring (every 2 months) of the Weight for Age (W/A) parameter and growth promotion in children from 0 to 24 months; vi) supplementation with Vitamin A every 6 months in children from 6 to 24 months, and ; vii) Supplementation with micronutrients powder (MNP) in children from 6 to 23 months (60 sachets every 6 months, that is, at 6, 12 and 18 months) The World Bank Mozambique Primary Health Care Strengthening Program (P163541) (vii) DLI 7 (human resources) – The 2023 targets are removed as there is no longer a budget allocation for that year for this DLI The amount allocated to this DLI is reduced from US$18 million to US$16 million. (viii) DLI 8 (scorecards in district/rural hospitals) – The amount allocated to this DLI is reduced from US$23.5 million to US$22.5 million. (ix) DLI 9 (scorecards and community consultations in health centers) - The amount allocated to this DLI is reduced from US$27 million to US$26 million. (x) DLI 10 (APEs) – A DLR for 2021 “Approval of the Decree recognizing Community Health Workers (CHWs) in the National Health System as state agents” is removed due to its incompatibility with the new Subcommunity Strategy developed in 2021. The 2022 target on the proportion of APEs meeting quality standards is reduced from 80 percent to 50 percent, considering the 28 percent result measured in January 2020. Reaching the originally proposed end target (80%) will require significant reform and investments and the risk of not achieving it is very high. The revised target (50%) is attainable given the renewed impetus on community health programs stemming from the newly approved community health strategy, highly owned by MISAU. The amount allocated to this DLI is reduced from US$26.5 million to US$19 million. (xi) DLI 11 (Civil Registration and Vital Statistics) – 2021 and 2022 targets of both DLRs are reduced for feasibility. “75 percent of deaths in eligible health facilities certified by a doctor or qualified clinician with cause of death coded using ICD10, and the death record captured in the SISMA MGDH” is reduced to 60 percent in 2021, and from 85 percent to 70 percent for 2022. While at the design stage, the likelihood of reaching high coverage was deemed realistic based on the assessment and information at hand, the implementation proved to be more complex requiring adjustments to the target by combining ambition and feasibility. Similarly, “30 percent of deaths registered, certified, and captured in the civil registration system (SiRCEV) within one year of occurrence” is decreased to 20 percent for 2021, and from 45 percent to 25 percent for 2022. With 51.7 percent of deaths in facilities with internment codified and recorded and 8.5 percent registered with the civil registry in 2020, the end targets would still require 55 percent and 194 percent increases respectively. These adjustments resulted from the lessons learned of implementation of the SiRCEV, which was slower than expected. The revised targets are more likely to be achieved. The amount allocated to this DLI is reduced from US$19.8 million to US$17.8 million. New targets were defined as a balance between achievable results against available funds and level of difficulty. (xii) DLI 12 (essential medicines availability) - The achievement against targets for 2019 and 2020 was not measured due to delays and methodological issues with the medicines’ availability study, and thus are being removed. Study results were released in mid-2022 indicating that levels of availability remain low, pointing to the need to rapidly advance on key reforms supported by the Program to date, as outlined in the Business Case for outsourcing last mile medicine’s delivery. Key process indicators are thus reflected in revised 2021 and 2022 DLRs to: (i) streamline the supply chain through the passage of the reforms creating a single command structure (commando único) and (iii) optimize medicine’s delivery through intermediate warehouses and outsourcing of last mile delivery. The amount allocated to this DLI is reduced from US$10 million to US$4.5 million. 6. The restructuring also includes modifications to two intermediate results indicators (IRIs) and a PDO indicator (detailed in Annex 1), based on data quality and measurement issues, and to streamline reporting. These modifications include: (i) The removal of the IRI “Number of health facilities providing Basic Emergency Obstetric and Newborn Care”, which has not been reliably measured to date. The indicator on Comprehensive Emergency Obstetric and Newborn Care will be retained, for which the Program supports its measurement; and The World Bank Mozambique Primary Health Care Strengthening Program (P163541) (ii) The removal of the IRI “Percentage of pregnant women who receive four doses of intermittent preventive treatment of malaria during their pregnancy”, to streamline and enhance focus on the PDO indicator “Number of lagging districts (as defined in the IC) that provide four doses of intermittent preventive treatment of malaria to at least 70 percent of pregnant women.” The end target of this PDO indicator, which was added in the mid-term restructuring in 2021, will be adjusted for feasibility (reducing the target coverage per district from 70 to 60 percent). 7. The disbursement estimates are revised to reflect the reduced envelope and progress of disbursement to date, which has been affected by the COVID-19 pandemic. 8. Finally, US$733,333.20 out of the total US$7 million committed by USAID to the Recipient Executed Trust Fund will be cancelled, due to partial achievement one of the DLIs to which the donor contributed (DLI 4) prior to their exit. The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Table 2. DLI Matrix Revisions Current DLI Matrix Revised DLI Matrix (Restructuring: March 2022) DLIs 2018 2019 2020 2021 2022 2023 2018 2019 2020 2021 2022 DLI 1: Previous: Percentage of Institution al Deliveries in the 42 lagging districts 37 of the 32 of the defined in 29 of the 42 32 of the 42 29 of the 42 37 of the 42 42 districts 42 districts the IC districts districts districts districts 66.8% 81% have at 66.8% 81% have at have at have at have at have at least institution institution least 85 institution institution least 85 least 85 least 85 least 85 85 percent New: al al percent of al al percent of percent of percent of percent of of Number of deliveries deliveries institution deliveries deliveries institution institutional institutional institutional institutional districts, al al deliveries deliveries deliveries deliveries out of the deliveries deliveries 42 identified as lagging in the Investmen t Case, with at least 85 percent of institution The World Bank Mozambique Primary Health Care Strengthening Program (P163541) al deliveries Total (US$ 5.7 5 4.5 4 3 5.7 5 4.5 4 2 Millions) Revised 2018 2019 2020 2021 2022 2023 2018 2019 2020 2021 2022 DLI 2: Percentage 19% of 40% of 60% of 80% of 19% of 40% of 50% of of technical secondary secondary secondary technical secondary secondary secondary schools and and and schools and and and offering technical technical technical offering technical technical technical SRH schools schools schools SRH schools schools schools services offering offering offering services offering offering SRH offering (US$4.0M) SRH SRH SHR (US$4.0M) SRH services sexual and services services services services (US$4M) reproducti (US$3.0M) (US$3.0M) (US$5.5M) (US$4.0M) ve health (SRH) Gaps Approval of Completio Gaps Approval services identificatio updated n of identificatio of (informati n in current training training n in current updated on and training materials for health training training contracept materials (US$1.0M) providers materials materials ive completed using new completed (US$1.0M) methods) (US$1.0M) training (US$1.0M) materials (US$1.0M) The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Harmonizati Approval of Completio Harmonizat Approval Completion on of M&E the n of ion of M&E of of training tools Adolescent training tools updated for health finalized and Youth- for health finalized Adolescen providers (US$1.0M) Friendly providers (US$1.0M) t and and focal Services and focal Youth- points on (SAAJ) points on Friendly improved Guidelines improved Services M&E tools (US$1.5M) M&E tools (SAAJ) (US$1M) (US$1.5M) Guidelines (US$1.5M) Total (US$ 6 5.5 5.5 5.5 6 6.5 5 Millions) DLI 3: Revised Couple 2018 2019 2020 2021 2022 2023 2018 2019 2020 2021 2022 Years of Protection 2,135,012 2,336,463 3,190,000 3,360,000 3,540,000 2,135,012 2,336,463 3,190,000 3,360,000 3,540,000 Total (US$ 3.5 5 4.5 4 3.5 3.5 5 4.5 4 3.5 Millions) DLI 4: Revised Percentage 2018 2019 2020 2021 2022 2023 2018 2019 2020 2021 2022 of children The World Bank Mozambique Primary Health Care Strengthening Program (P163541) between Key staff 15% of 40% of 60% of 80% of Key staff 15% of 30% of 40% of 0-24 identified children children children children identified children children children months of and benefiting benefiting benefiting benefiting and benefiting benefiting provinces age trained in from the from the from the from the trained in from the from the benefiting receiving NIP Modified NIP NIP NIP NIP Modified Modified from the NIP 5[$US2.5] NIP (due to [US$2.75M] [US$2.00 [$US2.5] NIP (due to NIP [US$4.5M] the Nutrition COVID-19) M] COVID-19) [US$6M] Interventio n Package [US$5.27M] (NIP) in M&E 75% 90% of M&E the eight system of nutrition nutrition system provinces finalized sites meet sites meet finalized (Cabo [US$1.0] minimum minimum [US$1.0] Delgado, quality quality Inhamban standards standards e, Manica, [US$2.75M] [US$2.00 Nampula, M] Niassa, Sofala, Tete and Zambézia) with a prevalence of stunting above 35 percent Total (US$ 3.5 6 5.5 5 4 3.5 5.27 6 4.5 Millions) DLI 5: Revised 5At least 6 trainers, 100 percent of district nutrition representatives, and 30 percent of Community Health Workers, and identified 30 percent of volunteers, in 6 of the 8 targeted provinces The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Actual 2018 2019 2020 2021 2022 2023 2018 2019 2020 2021 2022 domestic health expenditur es as a percentage of total domestic 8.50% 8.50% 9% 9.50% 8.50% 8.50% 9% 9.50% governme nt expenditur e per fiscal year Total (US$ 3.75 3.25 3.25 3.25 3.75 3.25 3.25 3.25 Millions) Revised 2018 2019 2020 2021 2022 2023 2018 2019 2020 2021 2022 6.3.1: 6.4.1: 6.5.1: 6.6.1: 6.3.1: 6.4. 6.5.Grants DLI 6: Actual Cumulative Cumulativ Cumulativ Actual Signing of disbursed for Increased provincial provincial e e provincial Program 90% of health expenditure expenditure provincial provincial expenditure Contracts primary expenditur s in the s in the expenditur expenditu s in the with health care es in Underserve Underserve es in the res in the Underserve eleven facilities with historically d Provinces d Provinces Underserv Underserv d Provinces provinces internment underserv from the from the ed ed from the [US$ 1M] in the three ed Sub- Sub- Provinces Provinces Sub- Underserved Provinces Account Account from the from the Account Provinces [$ Resources Resources Sub- Sub- Resources 3.0M] to US $ 9 to $ 18 Account Account to US $ 9 million [US million [$ Resources Resources million [US $ 1.0M] 1.0M] to $ 27 to US $ 36 $ 1.0M] million The World Bank Mozambique Primary Health Care Strengthening Program (P163541) 6.3.2: 6.4.2: million [$ [US $ 6.3.2: Actual Cumulative 1.0M] 1.0M] Actual district district district expenditure expenditure 6.5.2: 6.6.2: expenditure s in the s in the Cumulativ Cumulativ s in the Underserve Underserve e district e district Underserve d Districts d Districts expenditur expenditu d Districts from the from the es in the res in the from the Sub- Sub- Underserv Underserv Sub- Account Account ed ed Account Resources Resources Districts Districts Resources to $ 4 to $ 8 from the from the to $ 4 million [US$ million [US Sub- Sub- million [US$ 1.0M] $ 1.0 M] Account Account 1.0M] Resources Resources 6.3.3:Dome 6.4.3: to $ 12 to $ 16 6.3.3: stic Health Domestic million million Domestic Expenditure Health [US$ 1.0 [US$ 1.0 Health s for the Expenditure M] M] Expenditure Underserve s for the s for the d Areas Underserve 6.5.3: 6.6.3: Underserve maintained d Areas Domestic Domestic d Areas as a share maintained Health Health maintained of domestic as a share Expenditur Expenditu as a share provincial of domestic es for the res for the of domestic and district provincial Underserv Underserv provincial expenditure and district ed Areas ed Areas and district s [US expenditure maintaine maintaine health $1.0M] s [US$ d as a d as a expenditure 1.0M] share of share of s [US 6.3.4. domestic domestic $1.0M] Signing of 6.4.4. provincial provincial Program Signing of and and Contracts Program district district with the Contracts expenditur expenditu three with eleven The World Bank Mozambique Primary Health Care Strengthening Program (P163541) provinces. provinces.[ es [US$ res [US$ [US$ 0.5M] US$ 0.5M] 1.0M] 1.0M] Total (US$ 3.5 3.5 3 3 1 3 Millions) Revised 2018 2019 2020 2021 2022 2023 2018 2019 2020 2021 2022 15431 15,566 16182 17153 18163 15,431 15,566 16,182 17,153 DLI 7: [US$2.5M] [$2.0M] [US$1.5M] [US$1.5M] [US$1.0M] [US$2.5M] [$2.0M] [US$1.5M] [US$1.5M] Number of 688 (60%) 768 (67%) 838 (74%) 688 (60%) 728 (64%) technical health 704 (62%) 728 (64%) health health health 704 (62%) health health facilities in of health health facilities in facilities in facilities in of health facilities in 768 (67%) personnel the facilities in facilities in the the the facilities in the health assigned primary the primary the primary primary primary primary the primary primary facilities in to the 12,205 12,205 care care care care care care care care the primary primary network network network network network network network network care network health care have at have at have at have at have at have at have at have at have at least network least two least two least two least two least two least two least two least two two active active active MCH active MCH active active active active MCH active MCH nurses Maternal nurses nurses MCH MCH Maternal nurses MCH [US$1.0M] and Child [US$1.5M] [US$1.0M] nurses nurses and Child [US$1.5M] nurses Health [US$1.0M] [US$1.0M] Health [US$1.0M] (MCH) (MCH) The World Bank Mozambique Primary Health Care Strengthening Program (P163541) nurses nurses [US$1.5M] [US$1.5M] Total (US$ 3.5 4 3.5 2.5 2.5 2 3.5 4 3.5 2.5 2.5 Millions) Revised DLI 8: Number of 2018 2019 2020 2021 2022 2023 2018 2019 2020 2021 2022 district and rural Hospital 30% of 15 (30%) 31 (70%) 44 (100%) Hospital 30% of 15 (30%) 31 (70%) 44 (100%) hospitals performan district/rur district and district and district performan district/rur district and district district and receiving ce al rural rural and rural ce al rural and rural rural performan scorecards hospitals hospitals hospitals hospitals scorecards hospitals hospitals hospitals hospitals ce-based designed receive receive receive PBA receive designed receive receive receive receive PBA allocations and PBA allocations according PBA in and PBA allocations PBA according to (PBA) piloted in according based on to a accordanc piloted in according based on according a minimum according 6 to a prioritized minimum of e with a 6 to a prioritized to a of one to a district/rur minimum action plans one minimum district/rur minimum action plans minimum scorecard minimum al of two that scorecard of one al of two that of one assessment of one hospitals, scorecard respond to assessment scorecard hospitals, scorecard respond to scorecard in the last scorecard which assessmen scorecard in the last assessmen which assessmen scorecard assessmen FY assessmen receive ts in the evaluations FY t in the receive ts in the evaluations t in the t in the last PBA last year last FY PBA last fiscal last FY fiscal year according according year to their to their performan performan The World Bank Mozambique Primary Health Care Strengthening Program (P163541) ce ce Total (US$ 4 5.5 5.5 4.5 4 4 5.5 5.5 4.5 3 Millions) Revised 2018 2019 2020 2021 2022 2023 2018 2019 2020 2021 2022 DLI 9: Health 130 rural 186 health 261 health 391 health Health 130 rural 186 health 261 health 391 health Number of center health centers in centers in centers in center health centers in centers in centers in health performan centers in priority priority priority performan centers in priority priority priority centers in ce priority districts districts districts ce priority districts districts districts priority scorecards districts receive receive PBA receive scorecards districts receive receive receive PBA districts with receive financial according PBA with receive financial PBA according to receiving communit PBA allocations to at least according communit PBA allocations according at least one PBA y according based on one to at least y according based on to at least scorecard according consultati to at least prioritized scorecard one consultati to at least prioritized one assessment to a ons two action plans assessment scorecard ons two action plans scorecard with minimum designed scorecard that with assessmen designed scorecard that assessmen community of one and assessmen respond to community t with and assessmen respond to t with consultation scorecard piloted in ts with scorecard consultatio communit piloted in ts with scorecard communit s in the last assessmen at least 64 communit evaluations ns in the y at least 64 communit evaluations y FY t with health y last FY consultati health y consultati communit centers in consultati ons in the centers in consultati ons in the y priority ons in the last FY priority ons in the last FY consultatio districts, last fiscal districts, last fiscal ns in the with year with year last fiscal health health year centers centers receiving receiving financial financial allocations allocations according according to their to their The World Bank Mozambique Primary Health Care Strengthening Program (P163541) performan performan ce ce Total (US$ 4 6.5 6 5.5 5 4 6.5 6 5.5 4 Millions) Revised DLI 10: 2018 2019 2020 2021 2022 2023 2018 2019 2020 2021 2022 Number of active 10.1: 10.2.1: 10.3.1: 10.4.1: 10.5.1: 10.1: 10.2: 10.3: 6,690 10.4: 10.5.1: 8,800 communit 4,723 APEs 6,523 6,690 active 7,748 active 8,800 4,723 APEs 6,523 active 7,748 active CHWs y health trained APEs CHWs [US$ CHWs [US$ active trained APEs CHWs [US$ active [US$ 3.0M] workers and active trained 3.0M] 3.0M] CHWs and active trained 3.0M] CHWs (CHWs) and active [US$ and active [US$ [US$3.0M] 3.0M] [US$3.0M] 3.0M] The World Bank Mozambique Primary Health Care Strengthening Program (P163541) 10.4.2: 60% 10.5.2: 10.5.2: 50% of CHWs 80% of of CHWs deliver CHWs deliver services deliver services according services according to to according quality minimum to standards quality minimum [US$ 3.5M] standards quality [US$ 4.0M] standards [US$ 3.5M] 10.4.3. Approval of the Decree recognizing CHWs in the National Health System as state agents [US$ 3.5M] Total (US$ 3.5 3 3 10.5 6.5 3.5 3 3 3 6.5 Millions) DLI 11: Revised Previous: 2018 2019 2020 2021 2022 2023 2018 2019 2020 2021 2022 Percentage The World Bank Mozambique Primary Health Care Strengthening Program (P163541) of deaths 100% of 100% of 50% of 75% of 85% of 90% 100% of 70% of 50% of 60% of 70% of certified in hospitals health deaths in deaths in deaths in of deaths hospitals health deaths in deaths in deaths in health and 50% centers eligible eligible eligible in eligible and 50% centers eligible eligible eligible facilities of health use MGDH health health health health of health use MGDH health health health with data centers to facilities facilities facilities facilities centers to facilities facilities facilities on cause use the generate certified by certified by certified certified use the generate certified by certified certified by a of death Hospital informatio a doctor or a doctor or by a by a Hospital informatio a doctor or by a doctor or coded per Data n on the qualified qualified doctor or doctor or Data n on the qualified doctor or qualified the Managem causes of clinician clinician qualified qualified Managem causes of clinician qualified clinician with Internatio ent death with cause with cause clinician clinician ent death with cause clinician cause of nal Module of death of death with cause with the Module of death with cause death coded Classificati (MGDH) to coded using coded using of death cause of (MGDH) to coded using of death using ICD10 on of generate ICD10, and ICD10, and coded death generate ICD10, and coded or ICD 11, Disease informatio the death the death using coded informatio the death using and the 10th n about record record ICD10, and using n about record ICD10 or death record Edition the causes captured in captured in the death ICD10, the causes captured in ICD 11, captured in (ICD 10), of death the SISMA the SISMA record and the of death the SISMA and the the SISMA reported in MGDH MGDH captured death MGDH death MGDH SISMA and [US$3.2M] [US$3.2M] in the record [US$3.2M] record [US$2M) registered SISMA captured captured MGDH in the in the Revised: [US$1.84 SISMA SISMA Percentage M] MGDH MGDH of deaths [US$2.0M] [US$2.2M] The World Bank Mozambique Primary Health Care Strengthening Program (P163541) in eligible 15% of 30% of 45% of 70% of 15% of 20% of 25% of health deaths deaths deaths deaths deaths deaths deaths facilities registered, registered, registered, registered registered, registered, registered, certified certified, certified, certified, , certified, certified, certified, certified, by a doctor and and and and and and and or a captured in captured in captured captured captured in captured captured in qualified the civil the civil in the civil in the civil the civil in the civil the civil clinician registration registration registratio registratio registration registratio registration with cause system system n system n system system n system system of death (SiRCEV) (SiRCEV) (SiRCEV) (SiRCEV) (SiRCEV) (SiRCEV) (SiRCEV) coded within one within one within one within one within one within one within one using year of year of year of year of year of year of year of their ICD10 or occurrence occurrence occurrenc occurrenc their their occurrence ICD 11, [US$0.6M] [US$0.8M] e e occurrence occurrenc [US$0.5M] and the [US$0.46 [US$0.2M] [US$0.6M] e death M] [US$0.8M] record captured in SISMA Hospital Data Managem ent Module (Modulo de Gestão de Dados Hospitalar es- MGDH) and Percentage of deaths registered, certified, and captured The World Bank Mozambique Primary Health Care Strengthening Program (P163541) in the civil registratio n system (SiRCEV) within one year of their occurrence Total (US$ 3.0 4.5 3.8 4.00 2.3 2.20 3.0 4.5 3.8 3.0 2.50 Millions) Revised DLI 12: 2018 2019 2020 2021 2022 2023 2018 2019 2020 2021 2022 Reforms introduced Approval by to increase Expansion the Cabinet the of the of a decree availability Sistema de granting the of Informaçã Central de essential o, Gestão, Medicament maternal e Logística os e Artigos and das Médicos 70% 75% 80% 85% reproducti Unidades (CMAM) ve health Sanitárias autonomy to medicines (SIGLUS) enable an at primary to 85% of optimized health care health single facilities. facilities command (US$1.5M) structure (US$1.5M) The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Implementat ion of outsourcing of last mile transportati on and distribution (US$1.5M) Total (US$ 3.00 2.50 2.50 2.00 1.5 3 Millions) The World Bank Mozambique Primary Health Care Strengthening Program (P163541) III. SUMMARY OF CHANGES Changed Not Changed Change in Results Framework ✔ Change in Cancellations Proposed ✔ Reallocation between and/or Change in DLI ✔ Change in Disbursement Estimates ✔ Change in Implementing Agency ✔ Change in Program's Development Objectives ✔ Change in Program Scope ✔ Change in Loan Closing Date(s) ✔ Change in Disbursements Arrangements ✔ Change in Systematic Operations Risk-Rating Tool ✔ (SORT) Change in Safeguard Policies Triggered ✔ Change in Legal Covenants ✔ Change in Institutional Arrangements ✔ Change in Technical Method ✔ Change in Fiduciary ✔ Change in Environmental and Social Aspects ✔ Change in Implementation Schedule ✔ Other Change(s) ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_COMPONENTS_TABLE OPS_DETAILEDCHANGES_CANCELLATIONS_TABLE The World Bank Mozambique Primary Health Care Strengthening Program (P163541) CANCELLATIONS PROPOSED Value Current Cancellation New Reason for Ln/Cr/TF Status Currency Date of Amount Amount Amount Cancellation Cancellation IDA-D2650- Disburs 57,000,000.0 XDR 57,000,000.00 0.00 001 ing 0 TF-A6152- Disburs 25,000,000.0 USD 25,000,000.00 0.00 001 ing 0 TF-A9398- Disburs 44,950,000.0 USD 44,950,000.00 0.00 001 ing 0 UNFUNDED TF-B3368- Disburs BALANCE USD 7,000,000.00 733,333.20 13-Jul-2022 6,266,666.80 001 ing UNDER TRUST FUND TF-B4481- Disburs USD 3,000,000.00 0.00 3,000,000.00 001 ing OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Year Current Proposed 2018 0.00 23,859,600.00 2019 23,859,600.00 0.00 2020 77,241,240.00 53,381,620.60 2021 56,486,660.00 20,757,432.78 2022 38,812,500.00 52,518,013.62 2023 31,725,000.00 42,750,000.00 2024 12,375,000.00 10,500,000.00 OPS_DETAILEDCHANGES_EA_TABLE . The World Bank Mozambique Primary Health Care Strengthening Program (P163541) ANNEX 1: RESULTS FRAMEWORK . . Results framework Program Development Objectives(s) The Program Development Objective is to improve the utilization and quality of reproductive, maternal, child and adolescent health and nutrition services, particularly in underserved areas. Program Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline End Target Improve utilization of RMNCAH and Nutrition in underserved areas Number of districts, out of the 42 identified as lagging in the Investment Case, with at least 85 percent institutional deliveries 28.00 37.00 (Number) Number of Couple Years of Protection (Number) 1,722,692.00 3,450,000.00 Percentage of children aged 0-24 months receiving a Nutrition Intervention Package in eight priority provinces (with the 0.00 40.00 prevalence of stunting of above 35 percent) (Percentage) Action: This indicator has been Revised Improve the quality of RMNCAH-N in underserved areas Page 26 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline End Target Number of lagging districts (as defined in the IC) that provide four doses of intermittent preventive treatment of malaria to at 10.00 30.00 least 60 percent of pregnant women (Number) Action: This indicator has been Revised PDO Table SPACE Intermediate Results Indicators by Result Areas RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Service delivery outputs Percentage of women who had at least four antenatal visits 42.00 66.30 during their pregnancy (Percentage) People who have received essential health, nutrition, and 0.00 19,760,000.00 population (HNP) services (CRI, Number) Number of children immunized (CRI, Number) 0.00 5,100,000.00 Number of women and children who have received basic 0.00 9,720,000.00 nutrition services (CRI, Number) Number of deliveries attended by skilled health personnel 0.00 4,940,000.00 (CRI, Number) Number of provinces meeting annual Couple Years of Protection 7.00 11.00 growth targets (Number) Service readiness and availability Page 27 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Number of health facilities providing Basic Emergency Obstetric 68.00 300.00 and Newborn Care (Number) Action: This indicator has been Marked for Deletion Number of health facilities providing Comprehensive Emergency 33.00 60.00 Obstetric and Newborn Care (Number) Percentage of secondary and technical schools offering sexual and reproductive health services (information and contraceptive 0.00 50.00 methods) (Percentage) Action: This indicator has been Revised Average availability of tracer essential maternal and reproductive 62.00 85.00 health medicines at primary health care facilities (Percentage) Action: This indicator has been Marked for Deletion Human Resources for Health (HRH) Number of active community health workers (Number) 3,380.00 8,800.00 Number of technical health personnel assigned to the primary 11,970.00 17,153.00 health care network (Number) Action: This indicator has been Revised Number of technical staff assigned to type II rural health 3,787.00 6,325.00 centers (Number) Number of primary health care facilities that have at least two 638.00 768.00 maternal child health nurses (Number) Action: This indicator has been Revised Quality Page 28 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Number of district and rural hospitals that received performance-based allocations in accordance with a minimum of 0.00 44.00 one scorecard assessment in the previous fiscal year (Number) Number of health centers in priority districts that received performance-based allocations in accordance with at least one 0.00 391.00 scorecard assessment with community consultations in the previous FY (Number) Percentage of pregnant women who receive four doses of intermittent preventive treatment of malaria during their 60.00 70.00 pregnancy (Percentage) Action: This indicator has been Marked for Deletion Health Financing Domestic health expenditures as a percentage of total domestic 7.90 9.50 government expenditures (Percentage) Health sub-account expenditures in 3 historically underserved 0.00 9,000,000.00 provinces (Nampula, Zambezia, and Tete) (Amount(USD)) Action: This indicator has been Revised Health sub-account expenditures in 28 historically underserved 0.00 4,000,000.00 districts (Amount(USD)) Action: This indicator has been Revised Information for decision making Percentage of deaths in eligible health facilities certified by a doctor or qualified clinician with cause of death coded using 0.00 70.00 ICD10, and the death record captured in the SISMA MGDH (Percentage) Page 29 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Action: This indicator has been Revised Percentage of deaths registered, certified and captured in the civil registration system (SiRCEV) within one year of their 0.00 25.00 occurrence (Percentage) Action: This indicator has been Revised IO Table SPACE Disbursement Linked Indicators Matrix DLI IN01169829 ACTION The Recipient has increased the number of districts, out of the 42 identified as lagging in the Investment Case, with at least DLI 1 85 percent institutional deliveries Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Number 11,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 28.00 December 2018 0.00 December 2019 0.00 December 2020 29.00 4,500,000.00 No scalability Allocated Amount x [Actual December 2021 32.00 4,000,000.00 improvement for the DLR/Targeted] Page 30 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2022 37.00 3,000,000.00 improvement for the DLR/Targeted] December 2023 0.00 Action: This DLI has been Revised. See below. DLI IN01169535 ACTION The Recipient has increased the number of districts, out of the 42 identified as lagging in the Investment Case, with at least DLI 1 85 percent institutional deliveries Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome No Number 10,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 28.00 December 2018 0.00 December 2019 0.00 December 2020 29.00 4,500,000.00 No scalability Allocated Amount x [Actual Achievement up to DLR 1.4 – DLR 1.3] / December 2021 32.00 4,000,000.00 [DLR 1.4 – DLR 1.3] + undisbursed amount from previous targets met Allocated Amount x [Actual Achievement up to DLR 1.5 – DLR 1.4] / December 2022 37.00 2,000,000.00 [DLR 1.5 – DLR 1.4] + undisbursed amount from previous targets met December 2023 0.00 Page 31 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01169830 ACTION The Recipient has increased the percentage of institutional deliveries in the 42 lagging districts defined in the Investment DLI 1.1 Case Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome Yes Number 10,700,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 66.10 December 2018 66.80 5,700,000.00 No scalability Allocated Amount x [Actual December 2019 81.00 5,000,000.00 improvement for the DLR/Targeted] December 2020 0.00 December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01169831 ACTION The Recipient has increased the percentage of secondary and technical schools offering sexual and reproductive health DLI 2 services (information and contraceptive methods) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 11,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 32 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 0.00 Allocated Amount x [Actual December 2021 40.00 3,000,000.00 improvement for the DLR / Target] Allocated Amount x [Actual December 2022 60.00 3,000,000.00 improvement for the DLR / Target] Allocated Amount x [Actual December 2023 80.00 5,500,000.00 improvement for the DLR / Target] Action: This DLI has been Revised. See below. DLI IN01169986 ACTION The Recipient has increased the percentage of secondary and technical schools offering sexual and reproductive health DLI 2 services (information and contraceptive methods) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome No Percentage 12,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 19.00 4,000,000.00 improvement for the DLR / Target] Page 33 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2021 40.00 4,000,000.00 improvement for the DLR / Target] Allocated Amount x [Actual December 2022 50.00 4,000,000.00 improvement for the DLR / Target] December 2023 0.00 DLI IN01169832 ACTION The Recipient has increased the percentage of technical schools offering sexual and reproductive health services DLI 2.1 (information and contraceptive methods) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome No Percentage 4,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 19.00 4,000,000.00 No scalability December 2021 0.00 December 2022 0.00 December 2023 0.00 Action: This DLI has been Marked for Deletion Page 34 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01169833 ACTION DLI 2.2 The Recipient has completed an identification of gaps in training materials Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 December 2019 0.00 December 2020 Yes 1,000,000.00 No scalability December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01169834 ACTION DLI 2.3 The Recipient has finalized the harmonization of monitoring and evaluation tools Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 Page 35 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2019 0.00 December 2020 Yes 1,000,000.00 No scalability December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01169835 ACTION DLI 2.4 The Recipient has approved updated training materials Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 Yes 1,000,000.00 No scalability December 2022 0.00 December 2023 0.00 Page 36 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01169836 ACTION DLI 2.5 The Recipient has approved updated Adolescent- and Youth-friendly Services Guidelines Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 Yes 1,500,000.00 No scalability December 2022 0.00 December 2023 0.00 DLI IN01169837 ACTION DLI 2.6 The Recipient has completed training for health providers using new training materials Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 Page 37 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2019 0.00 December 2020 0.00 December 2021 0.00 December 2022 Yes 1,000,000.00 No scalability December 2023 0.00 Action: This DLI has been Marked for Deletion DLI IN01169838 ACTION DLI 2.7 The Recipient has trained health providers and focal points on improved monitoring and evaluation tools Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 0.00 December 2022 Yes 1,500,000.00 No scalability December 2023 0.00 Page 38 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Action: This DLI has been Revised. See below. DLI IN01169925 ACTION DLI 2.7 The Recipient has trained health providers and focal points on improved monitoring and evaluation tools Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 0.00 December 2022 Yes 1,000,000.00 No scalability December 2023 0.00 DLI IN01169839 ACTION DLI 3 The Recipient has increased Couple Years of Protection Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Number 20,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 1,722,692.00 Page 39 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2018 2,135,012.00 3,500,000.00 No Scalability Allocated Amount x [Actual December 2019 2,336,463.00 5,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2020 3,190,000.00 4,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 3,360,000.00 4,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 3,540,000.00 3,500,000.00 improvement for the DLR/Targeted] December 2023 0.00 DLI IN01169840 ACTION The Recipient has increased the percentage of children between 0-24 months of age receiving the Nutrition Intervention DLI 4 Package in the eight provinces with a prevalence of stunting above 35 percent Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 15,750,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 15.00 6,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 40.00 2,750,000.00 improvement for the DLR/Targeted] Page 40 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2022 60.00 5,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2023 80.00 2,000,000.00 improvement for the DLR/Targeted] Action: This DLI has been Revised. See below. DLI IN01170117 ACTION The Recipient has increased the percentage of children between 0-24 months of age receiving the Nutrition Intervention DLI 4 Package in the eight provinces with a prevalence of stunting above 35 percent Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 15,770,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 15.00 5,270,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 30.00 6,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 40.00 4,500,000.00 improvement for the DLR/Targeted] December 2023 0.00 Page 41 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01169841 ACTION The Recipient has trained at least 6 trainers, 100% of district nutrition representatives, and 30% of Community Health DLI 4.1 Workers, and identified 30% of volunteers, in 6 of the 8 targeted provinces Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output No Yes/No 2,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 Yes 2,500,000.00 No scalability December 2019 0.00 December 2020 0.00 December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01169842 ACTION DLI 4.2 The Recipient has finalized the Monitoring and Evaluation System Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No Page 42 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2018 Yes 1,000,000.00 No scalability December 2019 0.00 December 2020 0.00 December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01169843 ACTION DLI 4.3 The Recipient has increased the percentage of nutrition sites meeting the minimum quality standards Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 4,750,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 75.00 2,750,000.00 December 2022 0.00 December 2023 90.00 2,000,000.00 Page 43 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Action: This DLI has been Marked for Deletion DLI IN01169844 ACTION The Recipient has increased the Domestic Health Expenditures as a percentage of total Domestic Government DLI 5 Expenditures. Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 13,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 7.90 December 2018 8.50 3,750,000.00 No scalability Allocated Amount x [Actual December 2019 8.50 3,250,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2020 9.00 3,250,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 9.50 3,250,000.00 improvement for the DLR/Targeted] December 2022 0.00 December 2023 0.00 Page 44 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01169845 ACTION The Recipient has increased health expenditures from the Sub-Account Resources in underserved provinces (Nampula, DLI 6 Zambezia, Tete) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Amount(USD) 4,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 9,000,000.00 1,000,000.00 No scalability Allocated Amount x [Actual December 2021 18,000,000.00 1,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 27,000,000.00 1,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2023 36,000,000.00 1,000,000.00 improvement for the DLR/Targeted] Action: This DLI has been Revised. See below. Page 45 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01170065 ACTION The Recipient has increased health expenditures from the Sub-Account Resources in Underserved Provinces (Nampula, DLI 6 Zambezia, Tete) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Amount(USD) 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 9,000,000.00 1,000,000.00 improvement for the DLR/Targeted] December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01169846 ACTION The Recipient has increased health expenditures from the Sub-Account Resources in the 28 underserved districts in the DLI 6.1 three underserved provinces Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Amount(USD) 4,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 46 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 4,000,000.00 1,000,000.00 No Scalability Allocated Amount x [Actual December 2021 8,000,000.00 1,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 12,000,000.00 1,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2023 16,000,000.00 1,000,000.00 improvement for the DLR/Targeted] Action: This DLI has been Revised. See below. DLI IN01170881 ACTION The Recipient has increased health expenditures from the Sub-Account Resources in the 28 Underserved Districts in the three DLI 6.1 Underserved Provinces Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Amount(USD) 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 4,000,000.00 1,000,000.00 improvement for the DLR/Targeted] Page 47 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01169847 ACTION The Recipient has maintained Domestic Health Expenditures for the three underserved provinces (Nampula, Zambezia, DLI 6.2 Tete) as a share of provincial expenditures Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Amount(USD) 2,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 36.60 December 2018 0.00 December 2019 0.00 December 2020 36.60 500,000.00 No scalability December 2021 36.60 500,000.00 No scalability December 2022 36.60 500,000.00 No scalability December 2023 36.60 500,000.00 No scalability Action: This DLI has been Revised. See below. Page 48 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01170882 ACTION The Recipient has maintained Domestic Health Expenditures for the three Underserved Provinces (Nampula, Zambezia, Tete) DLI 6.2 as a share of provincial Domestic Health Expenditures Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Amount(USD) 500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 32.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 32.00 500,000.00 improvement for the DLR/Targeted] December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01169848 ACTION The Recipient has maintained Domestic Health Expenditures for the 28 underserved districts in the three underserved DLI 6.3 provinces as a share of district expenditures Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Amount(USD) 2,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 49 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Baseline 19.50 December 2018 0.00 December 2019 0.00 December 2020 19.50 500,000.00 No scalability December 2021 19.50 500,000.00 No scalability December 2022 19.50 500,000.00 No scalability December 2023 19.50 500,000.00 No scalabilty Action: This DLI has been Revised. See below. DLI IN01170883 ACTION The Recipient has maintained Domestic Health Expenditures for the 28 Underserved Districts in the three Underserved DLI 6.3 Provinces as a share of district Domestic Health Expenditures Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Amount(USD) 500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 16.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 16.00 500,000.00 improvement for the DLR/Targeted] Page 50 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01169849 ACTION DLI 6.4 The Recipient has increased the number of provinces with Program Contracts Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Number 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 3.00 500,000.00 No scalability December 2021 11.00 500,000.00 No scalability December 2022 0.00 December 2023 0.00 Action: This DLI has been Revised. See below. Page 51 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01170884 ACTION DLI 6.4 The Recipient has increased the number of provinces with Program Contracts Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 0.00 Allocated Amount x [Actual December 2021 11.00 1,000,000.00 improvement for the DLR/Targeted] December 2022 0.00 December 2023 0.00 DLI IN01170044 ACTION The Recipient has disbursed grants to 90% of primary health care facilities with internment in the three Underserved DLI 6.5 Provinces Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Percentage 3,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 Page 52 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 0.00 Allocated Amount x [Actual achievement up to DLR 6.5 – Baseline] / December 2022 90.00 3,000,000.00 [DLR 6.5 – Baseline] + undisbursed amount from previous targets m December 2023 0.00 Action: This DLI is New DLI IN01169850 ACTION DLI 7 The Recipient has increased the number of technical health personnel assigned to the primary health care network Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 12,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 11,970.00 December 2018 12,205.00 3,500,000.00 No Scalability Allocated Amount x [Actual December 2019 15,431.00 2,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2020 15,566.00 2,000,000.00 improvement for the DLR/Targeted] Page 53 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2021 16,182.00 1,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 17,153.00 1,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2023 18,163.00 1,000,000.00 improvement for the DLR/Targeted] Action: This DLI has been Revised. See below. DLI IN01170885 ACTION DLI 7 The Recipient has increased the number of technical health personnel assigned to the primary health care network Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 11,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 11,970.00 December 2018 12,205.00 3,500,000.00 No Scalability Allocated Amount x [Actual December 2019 15,431.00 2,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2020 15,566.00 2,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 16,182.00 1,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 17,153.00 1,500,000.00 improvement for the DLR/Targeted] December 2023 0.00 Page 54 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01169851 ACTION The Recipient has increased the number of health care facilities in the primary care network with at least two active DLI 7.1 Maternal Child Health Nurses Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 6,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 638.00 December 2018 0.00 Allocated Amount x [Actual December 2019 688.00 1,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2020 704.00 1,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 728.00 1,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 768.00 1,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2023 838.00 1,000,000.00 improvement for the DLR/Targeted] Action: This DLI has been Revised. See below. Page 55 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01170886 ACTION The Recipient has increased the number of health care facilities in the primary care network that have at least two active DLI 7.1 Maternal Child Health Nurses Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 5,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 638.00 December 2018 0.00 Allocated Amount x [Actual December 2019 688.00 1,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2020 704.00 1,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 728.00 1,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 768.00 1,000,000.00 improvement for the DLR/Targeted] December 2023 0.00 DLI IN01169852 ACTION Number of district and rural hospitals that received performance-based allocations in accordance with a minimum of one DLI 8 scorecard assessment in the previous fiscal year Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 18,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 56 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Baseline 0.00 December 2018 6.00 4,000,000.00 No Scalability Allocated Amount x [Actual December 2019 30.00 5,500,000.00 improvement for the DLR/Targeted] December 2020 0.00 Allocated Amount x [Actual December 2021 31.00 4,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 70.00 4,000,000.00 improvement for the DLR/Targeted] December 2023 0.00 Action: This DLI has been Revised. See below. DLI IN01173487 ACTION The Recipient has increased the number of district and rural hospitals receiving performance-based allocations in DLI 8 accordance with a minimum of one scorecard assessment in the previous fiscal year Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 17,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 6.00 4,000,000.00 No Scalability Allocated Amount x [Actual December 2019 30.00 5,500,000.00 improvement for the DLR/Targeted] December 2020 0.00 Page 57 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2021 31.00 4,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 70.00 3,000,000.00 improvement for the DLR/Targeted] December 2023 0.00 DLI IN01169853 ACTION The Recipient has increased the number of district and rural hospitals that receive allocations based on prioritized action DLI 8.1 plans that respond to scorecard evaluations Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 5,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 FY Allocated Amount x [Actual December 2020 15.00 5,500,000.00 Achievement up to DLR target/DLI target] December 2021 0.00 December 2022 0.00 December 2023 0.00 Page 58 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01169854 ACTION The Recipient has increased the number of health centers in priority districts receiving PBA according to one scorecard DLI 9 assessment with community consultations in the previous fiscal year Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 21,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 64.00 4,000,000.00 No scalability Allocated Amount x [Actual December 2019 130.00 6,500,000.00 improvement for the DLR/Targeted] December 2020 0.00 Allocated Amount x [Actual December 2021 261.00 5,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 391.00 5,000,000.00 improvement for the DLR/Targeted] December 2023 0.00 Action: This DLI has been Revised. See below. Page 59 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01173465 ACTION The Recipient has increased the number of health centers in priority districts receiving PBA according to at least one DLI 9 scorecard assessment with community consultations in the previous fiscal year Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 20,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 64.00 4,000,000.00 No scalability Allocated Amount x [Actual December 2019 130.00 6,500,000.00 improvement for the DLR/Targeted] December 2020 0.00 Allocated Amount x [Actual December 2021 261.00 5,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 391.00 4,000,000.00 improvement for the DLR/Targeted] December 2023 0.00 DLI IN01169855 ACTION The Recipient has increased the number of health centers in priority districts that received allocations to implement DLI 9.1 prioritized action plans responding to scorecards evaluations Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 6,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 60 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Baseline 0.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 186.00 6,000,000.00 improvement for the DLR/Targeted] December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01169856 ACTION DLI 10 The Recipient has increased the number of active Community Health Workers Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 15,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 3,380.00 December 2018 4,723.00 3,500,000.00 No scalability Allocated Amount x [Actual December 2019 6,523.00 3,000,000.00 improvement for the DLI/Targeted] Allocated Amount x [Actual December 2020 6,690.00 3,000,000.00 improvement for the DLI/Targeted] Allocated Amount x [Actual December 2021 7,748.00 3,000,000.00 improvement for the DLI/Targeted] Page 61 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2022 8,800.00 3,000,000.00 improvement for the DLI/Targeted] December 2023 0.00 DLI IN01169857 ACTION The Recipient has increased the percentage of Community Health Workers that deliver services according to minimum DLI 10.1 quality standards Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 7,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 28.00 December 2018 0.00 December 2019 0.00 December 2020 0.00 Allocated Amount x [Actual December 2021 60.00 4,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 80.00 3,500,000.00 improvement for the DLR/Targeted] December 2023 0.00 Action: This DLI has been Revised. See below. Page 62 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01173516 ACTION The Recipient has increased the percentage of Community Health Workers that deliver services according to quality DLI 10.1 standards Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 3,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 28.00 December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 0.00 Allocated Amount x [Actual December 2022 50.00 3,500,000.00 improvement for the DLR/Targeted] December 2023 0.00 DLI IN01169858 ACTION DLI 10.2 The Recipient has approved a Decree recognizing Community Health Workers as state agents of the National Health System Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 3,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No Page 63 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 Yes 3,500,000.00 No scalability December 2022 0.00 December 2023 0.00 Action: This DLI has been Marked for Deletion DLI IN01169859 ACTION The Recipient has increased the percentage of deaths in eligible health facilities certified by a qualified clinician with the DLI 11 cause of death coded using ICD10, and the death record captured in SISMA Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 10,240,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 50.00 3,200,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 75.00 3,200,000.00 improvement for the DLR/Targeted] Page 64 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2022 85.00 1,840,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2023 90.00 2,000,000.00 improvement for the DLR/Targeted] Action: This DLI has been Revised. See below. DLI IN01170110 ACTION The Recipient has increased the percentage of deaths in eligible health facilities certified by a qualified clinician with cause DLI 11 of death coded using ICD10/11, and the death record captured in SISMA Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 7,400,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 50.00 3,200,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 60.00 2,200,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 70.00 2,000,000.00 improvement for the DLR/Targeted] December 2023 0.00 Page 65 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01169860 ACTION The Recipient has increased the percentage of hospitals using the Hospital Data Management Module (MGDH) to generate DLI 11.1 information on causes of deaths Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Percentage 1,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 70.00 December 2018 100.00 1,500,000.00 No scalability December 2019 0.00 December 2020 0.00 December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01169861 ACTION The Recipient has increased the percentage of health centers using the Hospital Data Management Module (MGDH) to DLI 11.2 generate information on causes of deaths Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 6,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 Page 66 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2018 50.00 1,500,000.00 No scalability Allocated Amount x [Actual December 2019 100.00 4,500,000.00 improvement for the DLR/Targeted] December 2020 0.00 December 2021 0.00 December 2022 0.00 December 2023 0.00 Action: This DLI has been Revised. See below. DLI IN01170116 ACTION The Recipient has increased the percentage of health centers using the Hospital Data Management Module (MGDH) to DLI 11.2 generate information on causes of deaths Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 6,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 50.00 1,500,000.00 No scalability Allocated Amount x [Actual December 2019 70.00 4,500,000.00 improvement for the DLR/Targeted] December 2020 0.00 December 2021 0.00 Page 67 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2022 0.00 December 2023 0.00 DLI IN01169862 ACTION The Recipient has increased the percentage of deaths registered, certified and captured in the civil registration system DLI 11.3 (SiRCEV) within one year of their occurrence Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 2,060,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 15.00 600,000.00 No scalability Allocated Amount x [Actual December 2021 30.00 800,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 45.00 460,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2023 70.00 200,000.00 improvement for the DLR/Targeted] Action: This DLI has been Revised. See below. Page 68 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01170111 ACTION The Recipient has increased the percentage of deaths registered, certified and captured in the civil registration system DLI 11.3 (SiRCEV) within one year of their occurrence Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 1,900,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 15.00 600,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 20.00 800,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 25.00 500,000.00 improvement for the DLR/Targeted] December 2023 0.00 DLI IN01169863 ACTION The Recipient has increased the average availability of tracer essential maternal and reproductive health medicines at DLI 12 primary health care facilities Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome No Percentage 10,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 69 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Baseline 62.00 December 2018 0.00 December 2019 70.00 3,000,000.00 No scalability Allocated Amount x [Actual December 2020 75.00 2,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 80.00 2,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 85.00 2,000,000.00 improvement for the DLR/Targeted] December 2023 0.00 Action: This DLI has been Revised. See below. DLI IN01170887 ACTION The Recipient has introduced reforms to increase the availability of essential maternal and reproductive health medicines at DLI 12 primary health care facilities Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome No Text 3,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline Reforms not introduced December 2018 0.00 December 2019 0.00 December 2020 0.00 Page 70 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Expansion of the Sistema de Informação, Gestão, e December 2021 Logística das Unidades Sanitárias (SIGLUS) to 85% of 1,500,000.00 No scalability health facilities Approval by the Cabinet of a decree granting the Central de Medicamentos e Artigos Médicos December 2022 1,500,000.00 No scalability (CMAM) autonomy to enable an optimized single command structure December 2023 0.00 DLI IN01172771 ACTION DLI 12.1 Implementation of outsourcing of last mile transportation and distribution of medicines Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome No Yes/No 1,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 0.00 December 2022 Yes 1,500,000.00 December 2023 0.00 Action: This DLI is New Page 71 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Page 72 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) ANNEX 2: PROGRAM ACTION PLAN . . PAP_NOT_CHANGE_TBL Action Description Source DLI# Responsibility Timing Completion Measurement The Program Operations Manual shall be adopted by the Recipient in a manner satisfactory to the Ministry of Health Association. Technical (MOH) - DPC Due Date 30-Jun-2019 Approved POM The Program Management Unit (PMU) shall be assembled with a Terms of Reference and composition satisfactory to the Association (including experienced fiduciary personnel). Technical MOH - DPC Due Date 29-Jun-2018 PMU ToR IC/PES Alignment: (i) Annual discussions on the analysis of spending alignment with the Investment Analysis and discussions held on Case's priorities IC spending alignment as part of led by MISAU's MISAU (DAF and the Balanço do PES in Q1 focal point. Fiduciary Systems DPC) Recurrent Yearly annually. IC/PES Alignment: (ii) Provincial Program Contracts reviewed and updated annually with PES, including disaggregated DLI and results framework Provincial Program Contracts indicators. Fiduciary Systems DPC Recurrent Yearly updated annually. Annual accounts (i) Audit Report of the health Economic and (ii) Report on Action Plan Social Plan (PES) Fiduciary Systems MOH -DAF Recurrent Yearly implementation Page 73 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) audited within 12 months after the end of the fiscal year by the Administrative Tribunal; Resulting action plan produced, implemented, and reported on annually. Annual procurement review of PES within 12 months of the FY's end by an independent firm, covering regulatory compliance, performance, and VFM; Action plans implemented and reported on; Remedies against ineligible (i) Audit Report (n-1) expenditures and (ii) Report on Action Plan misprocurement. Fiduciary Systems MISAU & WB Recurrent Yearly implementation Annual updates on the implementation of the medium-term capacity development plan for the fiduciary staff at central, provincial, and district levels, Annual report on the including for implementation of the capacity ADUS. Fiduciary Systems MISAU (DAF) Recurrent Yearly development plan. A roll-out plan developed to implement direct facility financing (ADUS), including training on the Financial Management Manual and disbursement method for each Roll-out plan for ADUS facility. Fiduciary Systems DLI 8 MISAU Due Date 31-Jan-2021 implementation. Page 74 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) An Environmental Health Training Plan (including the EIA process, Waste Management, and Infection Semi-annual updates on the Prevention and implementation of the Control) and a Environmental Health Training monitoring tool Plan and Monitoring Tool, developed and including semi-annual scorecard updated semi- Environmental and Social results, submitted to the World annually. Systems DSA Recurrent Semi-Annually Bank. Gender and socio- cultural responsiveness (I): Engagement of a social development specialist to: (i) provide oversight for gender and socio-cultural sensitivity in the sector; (ii) lead the PAP IR review and enhancement of ToR developed and agreed with complaint the Bank handling Environmental and Social Social Development Specialist mechanisms Systems MISAU Due Date 29-Mar-2019 engaged Gender and socio- cultural responsiveness (II): Ensure approaches to gender and socio- cultural sensitivity are reflected in PAP IR; the curriculum Curriculum; and training of Training materials available at community health health centers and district/rural workers and hospitals; and health staff and supported by MISAU DRH, Number of trained staff in general appropriate Environmental and Social DSNP and MOH's and per province. materials. Systems Gender Unit Recurrent Continuous A three-year plan identifying and PAP IR addressing gaps and needs for Annual reporting on GRM improving the strengthening and results on health system's Environmental and Social MOH (DNSP, nature and number of complaints GRM developed Systems DNAM) Recurrent Yearly registered and resolved. Page 75 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) and implemented, including clear flows of information, accountability, and triage mechanisms. CMAM to retain a Pharmaceutical Waste Management specialist at all times during the Pharmaceutical Waste duration of the Environmental and Social Management Specialist hired and program. Systems CMAM Recurrent Continuous retained. An annual national report on pharmaceutical waste management produced by CMAM based on terms of reference agreed with the Environmental and Social Annual reports on pharmaceutical World Bank Systems CMAM Recurrent Yearly waste management. Develop and implement a Stakeholder Engagement Plan on Pharmaceutical Waste Disposal for district, provincial, and central hospitals and medical stores, identifying key players' roles from identification and preparation to Environmental and Social Stakeholder Engagement Plan monitoring. Systems CMAM Due Date 31-Mar-2022 completed and monitored. Establish, implement, and regularly monitor of an action plan to improve eSIP, including the integration of community health Semi-annual updates on the workers. Technical DLI 7 MISAU - DHR Recurrent Semi-Annually action plan for eSIP improvement. Page 76 of 77 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Develop a plan to gradually incorporate contracted personnel to the civil service and regularly report reductions in contracted staff (fora do quadro) in Semiannual reports on fora do primary health quadro personnel in primary care facilities. Technical DLI 7 MISAU - DHR Recurrent Semi-Annually health care facilities. . Page 77 of 77