The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) SOUTH ASIA | Afghanistan | Health, Nutrition & Population Global Practice | Recipient Executed Activities | Investment Project Financing | FY 2022 | Seq No: 2 | ARCHIVED on 20-Oct-2022 | ISR53207 | Implementing Agencies: United Nations Children’s Fund (UNICEF), United Nations Children’s Fund (UNICEF) Key Dates Key Project Dates Bank Approval Date: 24-May-2022 Effectiveness Date: 26-May-2022 Planned Mid Term Review Date: 16-Jan-2023 Actual Mid-Term Review Date: Original Closing Date: 30-Jun-2024 Revised Closing Date: 30-Jun-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to increase the utilization and quality of essential health services in Afghanistan. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name 1. Urgent provision of essential primary and secondary health services:(Cost $289.00 M) 2. Strengthening service delivery and project coordination:(Cost $44.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The World Bank approved US$333 million (US$314 million from Afghanistan Trust Fund (ARTF) and US$19 million from Global Financing Facility (GFF) to finance Afghanistan Health Emergency Response (HER) project which became effective on May 24, 2022. The project is being implemented by UNICEF which is successfully managing the Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS) across the 34 provinces of Afghanistan. 10/20/2022 Page 1 of 8 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic High High High Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and Moderate Moderate Moderate Sustainability Fiduciary Substantial Substantial Moderate Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other Substantial Substantial Substantial Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes To increase the utilization of essential health services IN01194913 ►Children who have received the third dose of the Pentavalent vaccine through project-financed facilities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 111,736.00 0.00 205,983.00 1,973,536.00 Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194915 ►FEMALE - Children who have received the third dose of the Pentavalent vaccine through project-financed facilities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 986,768.00 Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194916 ►Births occurring at project-financed facilities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 67,979.00 0.00 127,155.00 1,277,629.00 10/20/2022 Page 2 of 8 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194917 ►Visits for growth monitoring and counselling on age-appropriate infant and young child feeding among children aged 0-23 months received at project-financed facilities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 619,634.00 0.00 1,202,502.00 11,245,006.00 Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194918 ►FEMALE - The visits for growth monitoring and counselling on age-appropriate infant and young child feeding among children aged 0-23 months received at project-financed facilities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 5,622,503.00 Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 To increase the quality of essential health services IN01194914 ►Average Quality Checklist score for BPHS and EPHS facilities (Text) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Quality checklist Quality checklist scores scores are not are not currently being currently being monitored. This will be monitored. This will be done when the tools are done when the tools finalized and the TPM is are finalized and the onboard. Meanwhile Value 0.00 TPM is onboard. Baseline + 15 points Round 3 &4 of the Meanwhile Round 3 & existing TPM –ARTF – 4 of the existing TPM – TO will include the ARTF –TO will include Quality-of-Care the Quality-of-Care indicators and Patient indicators and Patient verification. verification. Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 Intermediate Results Indicators by Components Component 1: Urgent provision of essential primary and secondary health services IN01194919 ►Service Providers who receive timely and complete payments from UNICEF as per contractual obligations (Text) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target A single tranche valued First tranche at US$31 million (US$29.2million) for Value 0.00 80% covering the ARTF/HER July-August 2022 was Project was transferred transferred to SPs in 10/20/2022 Page 3 of 8 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) in July 2022 with July 2022. Second confirmation received tranche (US$29.2 from SPs. million) for September- October has been transferred in mid- September 2022. (Source: UNICEF) Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194921 ►BPHS and EPHS health facility staff who receive at least 90% of their salary on time in the past month (Text) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target As reported by the SPs for EPHS/BPHS, 100% of the health facility staff (25,818) As report by the SPs, received their salary 27,512 (100%) BPHS on time at all 2,311 Value and EPHS health facility 0.00 80% health facilities. staff received their (Source: Service monthly salary on time. provider report July 2022). Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 Currently, there are 3 modes of payments used by the SPs with the number of health facility staff paid through: • ; Bank Transfer - 8,467 (33%), • Direct Cash payment (by SPs or through MSPs) -14,979 (58%) • and Bank Transfer/Cash payment- 2,372(9%). (Source: Service provider report July 2022) The overall time for payment of salaries ranges from 1- 10 days and on average 5 days for Cash and Comments: Bank Transfer and 9 days for mixed method and varies across the provinces. This is being monitored closely. (Source: Service provider report July 2022) Note: Re-verifying the total number of staffs and health facilities as reported staffing numbers. IN01194923 ►BPHS and EPHS health facilities meeting minimum female staffing requirements (Text) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target As reported by SPs, out of the 2,311 As reported by SPs, out functional Health of the 2,311 Health facilities, female health facilities, females workers account for account for 35% (9,561) 37% (9,463) at with 77% (7,344) of the BPHS/EPHS facilities. females in BPHS Overall, 98% (2,273) Value facilities and 23% (2,217) 0.00 of the health facilities 95% in EPHS facilities. have at least one Overall, 98% of the female health worker Health Facilities have at (Midwife, Nutrition least one female health counselor, Vaccinators worker (midwife, Nutrition and female MDs) counselor, vaccinators). (Source: Service provider report July 2022). Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194925 10/20/2022 Page 4 of 8 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) ►Vaccinators and CHWs who are female (Text) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target CHW – Total 30,122 CHWs in 15,061 (97%) functional health posts with Female CHWs 15,043 (50%) and Male CHWs 15,079 as reported by SPs. (Source: Service provider report July CHW – Total 29,472 2022). Value (Male 15,171: Female 0.00 45% 14,301). Vaccinators – Total 2,836 (Female – 733 (26%) and Male - 2,104) as reported by SP’s staff lists (Source: Service provider report July 2022). Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194927 ►Female nutrition counsellors employed by Service Providers (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 2,280 nutrition counsellors (Female) employed by SPs To be provided in future Value 0.00 which are reported by 2,000.00 reports SPs (Source: Service provider report July 2022) Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194928 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 4,909,510.00 0.00 9,644,506.00 7,284,303.00 Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194929 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 2,963,109.00 0.00 4,462,543.00 5,646,697.00 IN01194930 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target 10/20/2022 Page 5 of 8 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) Value 111,736.00 0.00 205,983.00 1,973,536.00 Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194931 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 237,552.00 0.00 405,796.00 4,033,138.00 Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194932 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 67,979.00 0.00 131,860.00 1,277,629.00 Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194933 ►Family planning couple-years of protection provided at project-financed facilities (Number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45,628.00 0.00 85,214.00 739,737.00 Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 Component 2: Strengthening service delivery and project coordination IN01194920 ►Health workers who receive training or mentorship (Number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 1,893.00 8,000.00 Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 1,893 health workers received various trainings provided by SPs across 30/34 provinces as reported by Comments: SPs. (Source: Service provider report July 2022) IN01194922 ►EPHS facilities where at least one female staff member has been trained on counselling for gender-based violence, implementation of GBV referral protocols and case management. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target TPM Round 1 and 2 data collection is underway, data will be updated in the next reporting period. Information not Value Trainings on GBV 0.00 80% available yet counselling and overall case management with HER funding not yet begun. 10/20/2022 Page 6 of 8 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194924 ►Average score on the Quantified Quality Checklist sub-section for pharmaceutical products (Text) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target TPM Round 1 and 2 data collection is underway, Information not Value 0.00 Baseline + 15 points data will be updated in available yet. the next reporting period. Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 IN01194926 ►Beneficiaries who are satisfied with services received by the project (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target N/A – TPM pending. TPM Round 1 and 2 data Community verification collection is underway, Value 0.00 will be done in R3 75% data will be updated in TPM monitoring which the next reporting period. is currently on-going. Date 30-Jun-2022 23-Aug-2022 31-Aug-2022 30-Jun-2024 Meanwhile, beneficiary satisfaction has been monitored through UNICEF health extenders during the reporting period (June – July 2022 monitoring) around 513 (43.5% Male, 56.5% Female) beneficiaries have been interviewed in 34 provinces. Nearly 78% of the interviewed clients 407 reported being very satisfied or satisfied with the services received at BPHS/EPHS facility, 106 (20.6%) were normal and a Comments: small proportion (1.5%) were not satisfied or very unsatisfied. Out of all 34 provinces, eleven (11) provinces did not meet over 50% satisfaction performance, while very small proportion of people (6) answered that they have paid for service. In addition to UNICEF monitoring, beneficiary satisfaction is also being assessed through TPM and data will be available in the next reporting period. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P178775 TF-B8512 Effective USD 150.00 150.00 0.00 75.39 74.61 50% P178775 TF-B8514 Effective USD 19.00 19.00 0.00 9.61 9.39 51% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P178775 TF-B8512 Effective 24-May-2022 26-May-2022 26-May-2022 30-Jun-2024 30-Jun-2024 10/20/2022 Page 7 of 8 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) P178775 TF-B8514 Effective 24-May-2022 26-May-2022 26-May-2022 30-Jun-2024 30-Jun-2024 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 10/20/2022 Page 8 of 8