The World Bank Implementation Status & Results Report Mauritania Health System Support Project (P179558) Mauritania Health System Support Project (P179558) WESTERN AND CENTRAL AFRICA | Mauritania | IBRD/IDA | Investment Project Financing (IPF) | FY 2024 | Seq No: 1 | Archived on 09-Jun-2024 | ISR00683 Implementing Agencies: Ministry of Health 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 20-Mar-2024) Project Development Objective (PDO) is to improve the accessibility, quality, and use of reproductive, maternal, neonatal, child, and adolescent health and nutrition services in the selected regions, and in case of an Eligible Crisis or Emergency, to respond promptly and effectively to it. Has the Development Objective been changed since Board Approval of the Project Objective? No 2. COMPONENTS Name Improve quality and increase use of RMNCAH-N services :(Cost 55,000,000.00) Strengthen health systems:(Cost 15,030,000.00) Project management, monitoring and evaluation:(Cost 4,000,000.00) Contingent Emergency Response Component:(Cost 0.00) 3. OVERALL RATINGS Name Current Progress towards achievement of PDO Satisfactory Overall Implementation Progress (IP) Satisfactory Overall Risk Rating Substantial Jun 09, 2024 Page 1 of 12 The World Bank Implementation Status & Results Report Mauritania Health System Support Project (P179558) 4. KEY ISSUES & STATUS 4.1 Implementation Status and Key Decisions The Ministry of Health team has made significant progress in preparing for the implementation of the INAYA project. Many planned activities for implementation readiness were completed and the beginning of the project implementation is planned for early July 2014. 4.2 MPA Program Development Objective Original MPA Program Development Objective (Approved as part of Approval (Seq. 1) package on 06-Feb-2024) PrDO is to reduce maternal and neonatal mortality, and stunting among children under five years of age and to enhance national health system capacities for pandemic preparedness. Current MPA Program Development Objective (Approved as part of (Seq. ) package on ) 4.3 Multiphase Programmatic Approach (MPA) Status (Public Disclosure) The World Bank approved a US$74.03 million five-year (2024-2029) Mauritania Essential Quality Health Service for Universal Health Coverage Project Health System Support Project as Phase 1 of the Multiphase Programmatic Approach (MPA) on Advancing Universal Health Coverage Program for Human Capital in Mauritania -P179558- (Credit No 7524 - MR(SUW/SML); Credit No 7522-MR(PBA); Credit No7523-MR (WHR); Grant No. E299-MR and GFF Grant No TF-C4068) on 21st March 2024. The project development objective (PDO) is “to improve the accessibility, quality and use of reproductive, maternal, neonatal, child, and adolescent health and nutrition services in the selected regions, and in case of an Eligible Crisis or Emergency, to respond promptly and effectively to it”. This project uses Investment Project Financing (IPF) with Performance-based Financing (PBF), which combines results- based Financing with input-based financing. The results-based financing aims to promote equitable access to essential health and nutrition services for deprived communities by linking services availability and utilization with payment for quality services. The input-based financing will be financing activities that aims to strength the health system. Specifically, the project will assist the Government of Mauritania to: (i) provide essential primary health and nutrition services, targeting women, children and the vulnerable; (ii) support reforms and build the national capacity for pandemic prevention, preparedness, and response. The two Grants will be effective before the end of May and the three credits at the end of June. 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Jun 09, 2024 Page 2 of 12 The World Bank Implementation Status & Results Report Mauritania Health System Support Project (P179558) Rating at Approval Risk Category Approval Package - 21 Mar Proposed Rating 2024 Political and Governance Substantial Substantial Macroeconomic Substantial Substantial Sector Strategies and Policies Moderate Moderate Technical Design of Project or Program Substantial Substantial Institutional Capacity for Implementation and Substantial Substantial Sustainability Fiduciary Moderate Moderate Environment and Social Moderate Moderate Stakeholders Moderate Moderate Overall Substantial Substantial Jun 09, 2024 Page 3 of 12 The World Bank Implementation Status & Results Report Mauritania Health System Support Project (P179558) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes Increase the accessibility, quality, and use of RMNCAH-N services in the selected regions Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 53.4 Dec/2022 80.00 Dec/2028 Deliveries in a health facility Comments on Numerator: Number of deliveries in a health facility in target regions (Percentage) achieving targets Denominator: Number of livebirths in target regions (estimate) 50 Dec/2022 50 24-May-2024 50 24-May-2024 80 Dec/2028 Comments on Number of births attended among refugees by skilled health personnel such as medical Deliveries in a health achieving targets doctor or nurse or midwife, who has been educated and trained in the skills needed to facility among refugee manage normal (uncomplicated) pregnancies, childbirth, and immediate postnatal care as women (Percentage) well as in the identification, management and referral of complications in women and newborns. This definition of skilled health personnel excludes traditional birth attendants whether trained or not. 0.00 Dec/2022 00 24-May-2024 00 24-May-2024 54 Dec/2028 Comments on Number of births attended among adolescents aged 19 years old or below by skilled health Deliveries in a health achieving targets personnel such as medical doctor or nurse or midwife, who has been educated and trained facility by women in the skills needed to manage normal (uncomplicated) pregnancies, childbirth, and below 19 years of age immediate postnatal care as well as in the identification, management and referral of (Percentage) complications in women and newborns. This definition of skilled health personnel excludes traditional birth attendants whether trained or not. New users of modern 61,656 Dec/2022 61,656 24-May-2024 61,656 24-May-2024 376,121 Dec/2028 contraceptives among Comments on Number of new users of modern contraception among women ages 15-49 in target regions women ages 15 to 49 achieving targets (Number) Jun 09, 2024 Page 4 of 12 The World Bank Implementation Status & Results Report Mauritania Health System Support Project (P179558) New users of modern 870 Dec/2022 870 24-May-2024 870 24-May-2024 4,481 Dec/2028 contraceptives among refugee women ages 15 to 49 (Number) Exclusive breastfeeding of 27.20 Dec/2022 27.20 24-May-2024 27.20 24-May-2024 50.00 Dec/2028 children younger than five Comments on Percentage of infants younger than six months who are fed exclusively with breast milk for months (Percentage) achieving targets the first six months in target regions 0.00 Dec/2023 00 24-May-2024 00 24-May-2024 60.00 Dec/2028 Average quality score for Comments on Average score for health facilities on the basis of a quality of care assessment checklist, health facilities achieving targets including appropriate materials, documentation and qualified staff for quality RMNCAH-N (Percentage) and acute malnutrition management as part of the PBF program Individuals who needed 60 Apr/2021 60 24-May-2024 60 24-May-2024 30 Dec/2028 clinical care in the past 12 Comments on Numerator: Number of people who needed clinical care in the past 12 months but did not months but did not seek it achieving targets seek it due to financial constraints in target regions because of financial Denominator: Number of people who needed clinical care in the past 12 months in target constraints (Percentage) regions 6.2 Intermediate Results Indicators by Components Improve quality and increase use of RMNCAH-N services Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year People who have received 0 Dec/2023 0 24-May-2024 0 24-May-2024 9000000.00 Dec/2028 essential health, nutrition, and population (HNP) services (Number) Jun 09, 2024 Page 5 of 12 The World Bank Implementation Status & Results Report Mauritania Health System Support Project (P179558) Number of women and 0.00 Dec/2023 0 24-May-2024 0 24-May-2024 260500 Dec/2028 children who have received basic nutrition services (Number) Number of deliveries 0.00 Dec/2023 0 24-May-2024 0 24-May-2024 344999.00 Dec/2028 attended by skilled health personnel (Number) People who have 0.00 0 0 4500000.00 received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number) Number of children 0.00 Dec/2023 0 24-May-2024 0 24-May-2024 427211.00 Dec/2028 immunized (Number) Pregnant women who 32,978.00 Dec/2022 32,978 24-May-2024 32,978 24-May-2024 223,513.00 Dec/2028 attended at least four Comments on Number of pregnant women ages 15 to 49 who attended at least four prenatal care visits prenatal care visits with a achieving targets with a qualified health service provider in target regions qualified health worker (Number) Pregnant refugee 622.00 Dec/2022 622 24-May-2024 622 24-May-2024 3,157.00 Dec/2028 women who attended Comments on Pregnant refugee women aged 15-49 years old who received antenatal care at least four at least four prenatal achieving targets times care visits with a qualified health worker (Number) 0.00 Dec/2022 00 24-May-2024 00 24-May-2024 4,824.00 Dec/2028 Jun 09, 2024 Page 6 of 12 The World Bank Implementation Status & Results Report Mauritania Health System Support Project (P179558) Pregnant women Comments on Pregnant refugee women ages 19 years old or below who received antenatal care at least younger than 19 who achieving targets four times attended at least four prenatal care visits with a qualified health worker (Number) Mothers with newborns who 30,894 Dec/2022 30,894 24-May-2024 30,894 24-May-2024 209,390.00 Dec/2028 attended at least two Comments on Number of mothers with newborns who attended at least two postnatal care visits with a postnatal care visits with a achieving targets qualified health service provider qualified health worker (Number) Refugee mothers with 998 Dec/2022 998 24-May-2024 998 24-May-2024 5,065 Dec/2028 newborns who Comments on Number of mothers with a newborn(s) among refugees who received at least two postnatal attended at least two achieving targets care by a health worker postnatal care visits with a qualified health worker (Number) Mothers younger than 0.00 Dec/2022 00 24-May-2024 00 24-May-2024 9,367.00 Dec/2028 19 with newborns who Comments on Number of mothers ages 19 years old or below with a newborn(s) who received at least two attended at least two achieving targets postnatal care by a health worker postnatal care visits with a qualified health worker (Number) Health facilities with no 0.00 Dec/2022 60.00 Dec/2028 stock-out of essential Comments on Numerator: Health facilities under PBF contracts in target regions with no stock-out of medicines during the last achieving targets essential medicines in the preceding three months three months (Percentage) Denominator: Total number of health facilities under PBF contracts in target regions 0.00 Dec/2023 60.00 Dec/2028 Average health facility Comments on Average structural score of health facilities for the minimum package activity quality of care quality-of-care score for the achieving targets in target regions Jun 09, 2024 Page 7 of 12 The World Bank Implementation Status & Results Report Mauritania Health System Support Project (P179558) minimum package activity (Percentage) Average community 0.00 Dec/2023 0 24-May-2024 0 24-May-2024 70.00 Dec/2028 satisfaction score Comments on Average quality-of-care satisfaction score from the community survey in target regions (Percentage) achieving targets Strengthen health systems Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year PHC facilities meeting 30 Dec/2022 30 24-May-2024 30 24-May-2024 55 Dec/2028 minimum human resources Comments on Numerator: Number of public PHC facilities in target regions meeting human resources for for health standards achieving targets health standards (Percentage) Denominator: Total number of public PHC facilities in target regions Health facilities designed, 0.00 Dec/2023 0 24-May-2024 0 24-May-2024 50 Dec/2028 rehabilitated, and Comments on Numerator: Number of health facilities under PBF contracts in target regions affected by maintained according to achieving targets climate-related events without disruption of health and nutrition service delivery climate-resilient standards, Denominator: Total number of health facilities under PBF contracts in target regions affected ensuring continuity of service by climate-related events during extreme weather events and climate-related disasters (Percentage) People who have benefitted 0 Dec/2023 70 Dec/2028 from strengthened capacity Comments on Numerator: Number of actors involved in the surveillance who have obtained satisfactory to prevent, detect, and achieving targets score (more than 80%) during a formative supervision respond to health Denominator: Number of actors involved in the surveillance who were supervised emergencies (Percentage) 0 Oct/2023 20 Dec/2028 Climate and disaster risk Comments on Numerator: Number of climate and disaster risk management indicators with green color management scorecard for achieving targets that are associated with positive outcomes or low risk health system (Percentage) Denominator: 85 indicators Jun 09, 2024 Page 8 of 12 The World Bank Implementation Status & Results Report Mauritania Health System Support Project (P179558) 0 Dec/2023 70 Dec/2028 Identified emergency Comments on Numerator: Number of identified emergency obstetric and newborn care facilities that met obstetric and newborn care achieving targets national standards in target regions facilities met national Denominator: Number of identified emergency obstetric and newborn care facilities in standards (Percentage) target regions 3 Dec/2023 3 24-May-2024 3 24-May-2024 5 Dec/2028 Interoperable, Comments on Number as joint external evaluation score: interconnected, electronic achieving targets 1 = no capacity (no system), 2 = limited capacity (country is developing a system), 3 = real-time disease surveillance developed capacity (country has developed a system but is unable to share data in real- reporting systems time), 4 = demonstrated capacity (country has a system, but the government does not fully (Number) sustain it), 5 = sustainable capacity (country has and sustains a system and shares data wit Project management, monitoring and evaluation Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 40 Dec/2023 40 24-May-2024 40 24-May-2024 80 Dec/2028 Public health facilities under Comments on Numerator: Number of public health facilities under PBF contracts in target regions PBF contracts (Percentage) achieving targets Denominator: Total number of public health facilities in target regions Public health facilities 0.00 Dec/2023 0 24-May-2024 0 24-May-2024 95.00 Dec/2028 submitting timely monthly Comments on Numerator: Public health facilities in target regions that submitted timely, complete monthly reports at the department achieving targets reports through the health information management system (Moughataa) level in the Denominator: Total number of public health facilities in target regions three preceding months Timeliness: Reports submitted between first and tenth of following month (Percentage) Completeness: Relevant information about facility complete Complaints recorded during 0.00 Dec/2023 0 24-May-2024 0 24-May-2024 90.00 Dec/2028 implementation and delivery Comments on Numerator: Number of complaints submitted and addressed of project benefits addressed achieving targets Denominator: Number of complaints recorded (Percentage) 33.00 Dec/2022 33 24-May-2024 33 24-May-2024 100.00 Dec/2028 Jun 09, 2024 Page 9 of 12 The World Bank Implementation Status & Results Report Mauritania Health System Support Project (P179558) Catchment communities with Comments on Numerator: Number of catchment communities in the target regions with an operational a functional health achieving targets health committee committee (Percentage) Denominator: Total number of catchment communities in the target regions Jun 09, 2024 Page 10 of 12 The World Bank Implementation Status & Results Report Mauritania Health System Support Project (P179558) 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-C4068 Effective 15.00 15.00 0.00 0.00 15.00 0% Not IDA-75230 10.00 10.00 0.00 0.00 10.01 0% Effective Not IDA-75220 2.30 2.30 0.00 0.00 2.37 0% Effective Jun 09, 2024 Page 11 of 12 The World Bank Implementation Status & Results Report Mauritania Health System Support Project (P179558) Not IDA-75240 30.00 30.00 0.00 0.00 29.78 0% Effective Not IDA-E2990 10.00 10.00 0.00 0.00 10.03 0% Effective 7.3 Key Dates (by loan) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing Not IDA-75220 21-Mar-2024 03-Apr-2024 30-Jun-2029 30-Jun-2029 Effective Not IDA-75230 21-Mar-2024 03-Apr-2024 30-Jun-2029 30-Jun-2029 Effective Not IDA-75240 21-Mar-2024 03-Apr-2024 30-Jun-2029 30-Jun-2029 Effective Not IDA-E2990 21-Mar-2024 03-Apr-2024 30-Jun-2029 30-Jun-2029 Effective TF-C4068 Effective 21-Mar-2024 03-Apr-2024 29-May-2024 30-Jun-2029 30-Jun-2029 8. KEY DATES Key Events Planned Actual Approval 21-Mar-2024 21-Mar-2024 Effectiveness 15-Jul-2024 Mid-Term Review No. 01 24-Nov-2026 Operation Closing/Cancellation 30-Jun-2029 9. RESTRUCTURING HISTORY 10. ASSOCIATED OPERATION(S) There are no associated operations Jun 09, 2024 Page 12 of 12