The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) SOUTH ASIA | Afghanistan | IBRD/IDA | Investment Project Financing (IPF) | FY 2022 | Seq No: 7 | Archived on 30-May-2024 | ISR00524 Implementing Agencies: United Nations Children’s Fund (UNICEF) 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 23-May-2022) To increase the utilization and quality of essential health and nutrition services in Afghanistan. Has the Development Objective been changed since Board Approval of the Project Objective? No 2. COMPONENTS Name 1. Urgent provision of essential primary and secondary health services:(Cost 439,260,000.00) 2. Strengthening service delivery and project coordination:(Cost 130,740,000.00) 3. Strengthening demand and access to enhance nutritional outcomes among the most vulnerable:(Cost 30,000,000.00) 3. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial 4. KEY ISSUES & STATUS 4.1 Implementation Status and Key Decisions May 30, 2024 Page 1 of 10 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) Project Performance: The Project Development Objective (PDO) and Intermediate Result Indicators (IRIs) remain satisfactory. Service delivery volume indicators are at 86-87 percent of the adjusted target, and the quality of care score has improved from 36 to 41 percent, aiming for 51 percent. The Maternal and Child Benefit Program (MCBP) is in the early stages, pending the Ministry of Public Health's approval for cash transfer guidelines. Nearly half of the IRIs have been achieved and six are not yet applicable. The project's implementation is satisfactory. UNICEF and WFP are effectively addressing service delivery issues and aiding the MCBP rollout. Key achievements include: (i) The performance of Service Providers enhanced from 69 to 77 percent, which has ensured an improved delivery of health and nutrition services for women and children (Component 1); (ii) Enhanced outbreak surveillance and response, with 558 outbreaks detected and 58,000 patients treated; (iii) Better quality performance via the Quantified Quality Metrics; (iv) Progress with UNICEF on a hybrid drug procurement model, including a draft Drug Procurement Strategy/Road Map (Component 2); (v) MCBP readiness in seven districts, promoting demand for health and nutrition services, with ongoing community engagement and beneficiary identification in areas with agreements (Component 3). 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Last Approved Rating Risk Category Approval Package - ISR Seq. 06 - 08 Mar Proposed Rating 24 May 2022 2024 Political and Governance High High High Macroeconomic High High High Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Moderate Moderate Moderate Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Moderate Substantial Substantial Overall Substantial Substantial Substantial May 30, 2024 Page 2 of 10 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes To increase the utilization of essential health services Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Children who have received 0.00 Jun/2022 1,691,566 31-Mar-2024 1,691,566 31-Mar-2024 2,752,271.00 Jun/2025 the third dose of the Pentavalent vaccine through project-financed facilities (Number) FEMALE - Children who 0.00 Jun/2022 584,149.00 30-Aug-2023 1,376,135.00 Jun/2025 have received the third dose of the Pentavalent vaccine through project-financed facilities (Number) Births occurring at project- 0.00 Jun/2022 1,062,671 31-Mar-2024 1,062,671 31-Mar-2024 1,785,803.00 Jun/2025 financed facilities (Number) To increase the quality of essential health services Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Tools for Jun/2022 41 31-Dec-2023 41 31-Dec-2023 51 Jun/2025 Average Quality Checklist Quality of Care score for BPHS and EPHS Checklist were facilities (Text) under development May 30, 2024 Page 3 of 10 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) To increase the utilization and quality of essential nutrition services Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Visits for growth monitoring 0.00 Jun/2022 6,911,311.00 30-Aug-2023 15,945,156.00 Jun/2025 and counseling on age- appropriate infant and young child feeding among children age 0-23 months received at project-financed facilities (Number) FEMALE - The visits for 0.00 Jun/2022 5,052,315 30-Aug-2023 5,052,315 30-Aug-2023 7,972,578.00 Jun/2025 growth monitoring and counselling on age- appropriate infant and young child feeding among children aged 0- 23 months received at project-financed facilities (Number) MCBP beneficiary 0.00 0.00 0.00 70.00 children who attended visits for growth monitoring and IYCF counseling (Percentage) Beneficiaries of social safety 0.00 Nov/2023 0.00 07-Nov-2023 140,000.00 Jun/2025 net programs (Number) MCBP beneficiaries 0.00 Nov/2023 0.00 21-May-2024 0.00 21-May-2024 70,000.00 Jun/2025 who are women (Number) May 30, 2024 Page 4 of 10 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) MCBP beneficiaries 0.00 Nov/2023 0.00 07-Nov-2023 0.00 07-Nov-2023 70,000.00 Jun/2025 who are children under 2 (Number) 6.2 Intermediate Results Indicators by Components 1. Urgent provision of essential primary and secondary health services Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Service providers who 47% Jun/2022 86% 21-May-2024 86% 21-May-2024 80% Jun/2025 receive timely and complete payments from UNICEF as per contractual obligations (Text) BPHS and EPHS health facility 74% Jun/2022 72% 31-Dec-2023 72% 31-Dec-2023 80% Jun/2025 staff who receive at least 90% of their salary on time in the past month (Text) BPHS and EPHS health 95% Jun/2022 97% 31-Dec-2023 97% 31-Dec-2023 95% Jun/2025 facilities meeting minimum female staffing requirements (Text) Vaccinators and CHWs who 37% Jun/2022 37% 30-Aug-2023 40% Jun/2025 are female (Text) Female nutrition counselors 1,949 Jun/2022 2287 21-May-2024 2287 21-May-2024 2000 Jun/2025 employed by Service providers (Text) Family planning couple-years 0.00 Jun/2022 659,770 31-Mar-2024 659,770 31-Mar-2024 1,076,070.00 Jun/2025 of protection provided at May 30, 2024 Page 5 of 10 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) project-financed facilities (Number) Basic health and nutrition 5,240,973.00 Apr/2023 9,863,927 31-Mar-2024 9,863,927 31-Mar-2024 8,323,898.00 Jun/2025 services provided to girls and women through the HER project (Number) Female health workers 9,634.00 Apr/2023 10,322.00 31-Oct-2023 10,322.00 31-Oct-2023 9,634.00 Jun/2025 employed at the HER project- financed health facilities (Number) Children who have received 0.00 Nov/2023 257739 31-Mar-2024 257739 31-Mar-2024 1,581,299.00 Jun/2025 the first dose of the Pentavalent vaccine through project-financed facilities (Number) People receiving quality 0.00 Jul/2022 9908252 31-Mar-2024 9908252 31-Mar-2024 12,146,153.00 Jun/2025 health, nutrition, and population services (Number) 2. Strengthening service delivery and project coordination Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year EPHS facilities where at least N/A Jun/2022 6% 30-Aug-2023 80% Jun/2025 one female staff member has been trained on counseling for gender-based violence, implementation of GBV referral protocols and case management (Text) 0 Aug/2023 4 31-Dec-2023 4 31-Dec-2023 15 Jun/2025 May 30, 2024 Page 6 of 10 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) Average score on the Comments on Note that this indicator requires a two-month stock available at the health facilities. So a 0% Quantified Quality Checklist achieving targets result does NOT necessarily indicate that no drugs are available at the facilities. subsection for pharmaceutical products (Text) Beneficiaries who are No available Jun/2022 93% 31-Dec-2023 93% 31-Dec-2023 75% Jun/2025 satisfied with services received by the project (Text) 3. Strengthening demand and access to enhance nutritional outcomes among the most vulnerable Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Pregnant women benefiting 0.00 Nov/2023 0.00 21-May-2024 0.00 21-May-2024 70.00 Jun/2025 from MCBP who give birth at project-financed facilities (Percentage) MCBP beneficiaries 0.00 Nov/2023 0.00 07-Nov-2023 80.00 Jun/2025 participating in SBCC sessions (Percentage) MCBP beneficiaries able to 0.00 Nov/2023 0.00 21-May-2024 0.00 21-May-2024 70.00 Jun/2025 recall at least three key nutrition messages (Percentage) MCBP beneficiaries with TBD Nov/2023 TBD 21-May-2024 TBD 21-May-2024 TBD Jun/2025 children 0-5 months who are breastfeeding (Text) Grievances, complaints, and 0.00 Nov/2023 0.00 21-May-2024 0.00 21-May-2024 80.00 Jun/2025 inquiries related to the MCBP intervention addressed within timeframe outlined in May 30, 2024 Page 7 of 10 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) project operations manual (Percentage) Food Consumption Score TBD Nov/2023 TBD 21-May-2024 TBD 21-May-2024 >35 Jun/2025 among MCBP beneficiary households (Text) May 30, 2024 Page 8 of 10 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) 7. DATA ON FINANCIAL PERFORMANCE 7.1 Cumulative Disbursements 7.2 Disbursements (by loan) Loan/Credit/TF Status Original Revised Cancelled Disbursed Undisbursed % Disbursed TF-B8514 Effective 19.00 19.00 0.00 19.00 0.00 100.00% TF-B8512 Effective 314.00 314.00 0.00 264.81 49.19 84.33% TF-C3368 Effective 20.00 20.00 0.00 18.96 1.04 94.79% TF-C3373 Effective 20.00 20.00 0.00 0.00 20.00 0% TF-C3372 Effective 130.00 130.00 0.00 0.00 130.00 0% May 30, 2024 Page 9 of 10 The World Bank Implementation Status & Results Report AFGHANISTAN HEALTH EMERGENCY RESPONSE (HER) PROJECT (P178775) 7.3 Key Dates (by loan) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing TF-B8512 Effective 24-May-2022 26-May-2022 26-May-2022 30-Jun-2024 30-Jun-2025 TF-B8514 Effective 24-May-2022 26-May-2022 26-May-2022 30-Jun-2024 30-Jun-2025 TF-C3368 Effective 16-Nov-2023 15-Dec-2023 15-Dec-2023 30-Jun-2025 30-Jun-2025 TF-C3372 Effective 16-Nov-2023 15-Dec-2023 15-Dec-2023 30-Jun-2025 30-Jun-2025 TF-C3373 Effective 16-Nov-2023 15-Dec-2023 15-Dec-2023 30-Jun-2025 30-Jun-2025 8. KEY DATES Key Events Planned Actual Approval 24-May-2022 24-May-2022 Effectiveness 30-May-2022 26-May-2022 Mid-Term Review No. 01 16-Jan-2023 18-Jan-2023 Operation Closing/Cancellation 30-Jun-2025 9. RESTRUCTURING HISTORY Restructuring Level 2 Approved on 26-Apr-2024 Restructuring Level 2 Approved on 24-May-2023 10. ASSOCIATED OPERATION(S) There are no associated operations May 30, 2024 Page 10 of 10