The World Bank Implementation Status & Results Report Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Nigeria Improved Child Survival Program for Human Capital MPA (P167156) WESTERN AND CENTRAL AFRICA | Nigeria | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 6 | ARCHIVED on 13-Jun-2023 | ISR55636 | Implementing Agencies: Federal Ministry of Health, Federal Republic of Nigeria, National Primary Health Care Development Agency (NPHCDA) Key Dates Key Project Dates Bank Approval Date: 18-Feb-2020 Effectiveness Date: 17-Feb-2021 Planned Mid Term Review Date: 30-Nov-2023 Actual Mid-Term Review Date: Original Closing Date: 31-Dec-2025 Revised Closing Date: 31-Dec-2025 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective (PDO) of the first phase (IMPACT) is to improve the utilization and quality of immunization plus and malaria services in selected states. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1:Malaria Control:(Cost $188.00 M) Component 2: Immunization Plus:(Cost $409.30 M) Component 3: Knowledge for Change:(Cost $52.70 M) Component 4: Contingent Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Unsatisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions 1. The project is in its third year of implementation following approval by the World Bank Board on February 18, 2020. After the initial delays in project effectiveness, the project is making fairly good progress with the implementation of critical activities. The absence of recent data from the Nigeria Demographic and Health Survey and the National Nutrition and Health Survey (NNHS aka SMART) limits our ability to objectively assess progress against baseline. However, proxy data suggests a positive direction for key PDO indicators. From the 2021 MICS/NICS results, 56.6 percent of children ages (12-23) months are vaccinated with third dose of Pentavalent Vaccine (percentage) compared to 33.3 in 2016. Though project baseline for malaria indicators was set from a different survey (SMART), data from the Malaria Indicator Survey (MIS 2021 compared with the 2015), show improvements in the treatment of malaria in Children but a decline in the use of insecticide treated nets among the same age group. the Percentage of febrile children under five in the last two weeks who were treated with ACTs improved from 7.6 to 18.1 between 2015 and 2021, however, the use of insecticide treated nets in this age group dropped to 41.2 percent nationally, from 43.6 percent in MIS 2015. 6/13/2023 Page 1 of 10 The World Bank Implementation Status & Results Report Nigeria Improved Child Survival Program for Human Capital MPA (P167156) 2. The IMPACT project now has 20 participating states (15 implementing the immunization plus component and five implementing the Malaria component). Project implementation has fully commenced at the National and state levels. All but two states (Gombe and Lagos) have received operational funds. States participating in the Immunization plus component of the IMPACT project have received their allocated funds for onward to each participating Primary Healthcare Center (PHC) in their state. This investment fund is spent directly by PHCs according to their identified need for minor renovations and equipment. Over 2700 facilities now have access to the investment fund in 12 states. 3. The Mid-term review of the project is expected at the end of this calendar year. The midterm review will present an opportunity for in-depth review of project performance and an opportunity for appropriate actions to enhance the performance of the project. MPA Program Development Objective MPA PDO Table The objective of the program is to reduce under-five mortality rate in program areas. MPA Table Multiphase Programmatic Approach (MPA) Status MPA Table Body The MPA is a ten year engagement from 2020 to 2030 with three phases. Phase one (IMPACT) is from Feb 2020 to Dec 31, 2025. The second phase is to support the implementation of the Basic Health Care Provision Fund (BHCPF) while the third phase will support states that are lagging in key health indicators. The project was approved in February 2020 and became effective in February 18, 2021 with actual disbursement starting in December 2021. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High Moderate Moderate Macroeconomic High Substantial Substantial Sector Strategies and Policies Low Low Low Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Moderate Moderate Sustainability Fiduciary Substantial Moderate Moderate Environment and Social Moderate Moderate Moderate Stakeholders Low Low Low Other -- -- -- Overall Substantial Moderate Moderate 6/13/2023 Page 2 of 10 The World Bank Implementation Status & Results Report Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Results PDO Indicators by Objectives / Outcomes Reducing under-5 mortality rate IN01273969 ►Under-five mortality rate (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 132.00 132.00 132.00 112.00 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Probability of dying between birth and exactly five years of age expressed per 1,000 live birth. The baseline for this indicator was based on NDHS 2018. The survey has not been conducted since then. Current Actual will be updated if NDHS is conducted or source of data is changed at restructuring. A proxy Comments: source of data for this indicator the Multiple indicator cluster survey shows an improvement – a decline from 120/1000 live births in 2016 to 102/1000 in 2021. 1. To improve utilization of malaria (preventive and curative) services IN01273968 ►Percentage of children under five sleeping under Long-Lasting Insecticide Nets (LLINs) the night prior to the survey (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 28.50 41.20 28.50 41.00 Date 31-Dec-2019 08-Aug-2022 08-Aug-2022 31-Dec-2025 Percentage of children under five sleeping under Long-Lasting Insecticide Nets (LLINs) the night prior to the survey. The baseline for this indicator was based on the average 2018 SMART survey score in the original 6 malaria states. The survey has not been conducted since 2019. Current Actual will be Comments: updated if SMART survey is repeated or source of data is changed at restructuring. The proxy source of data for this indicator the Malaria Indicator survey 2021 indicates a decline in coverage from 43.4 percent in 2016 to 41.2 percent in 2021. IN01273982 Percentage girls under-five who slept under Long-Lasting Insecticide Nets (LLINs) the night prior to the survey (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 29.10 29.10 29.10 41.00 IN01273984 ►Percentage of febrile children under five in the last two weeks who were treated with ACTs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.40 32.40 32.40 42.40 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 6/13/2023 Page 3 of 10 The World Bank Implementation Status & Results Report Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Percentage of febrile children under five in the last two weeks who were treated with ACTs. The baseline for this indicator was based on the national 2018 SMART survey. The data is not disaggregated by state. The survey has not been conducted since 2019. Current Actual will be updated if SMART survey Comments: is repeated or source of data is changed at restructuring. The proxy source of data for this indicator the Malaria Indicator survey 2021 indicates a significant increase from 37.6 percent in 2016 to 73.5 percent in 2021. IN01273987 Percentage febrile girls under-five in the last two weeks who were treated with ACTs (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 30.70 30.70 30.70 42.40 2. To improve utilization of immunization plus (immunization, maternal and neonatal) services IN01273970 ►Percentage of children ages (12-23) months vaccinated with third dose of Pentavalent Vaccine (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 48.70 56.60 56.60 64.40 Date 31-Dec-2019 08-Aug-2022 08-Aug-2022 31-Dec-2025 Percentage of children ages (12-23) months vaccinated with third dose of Pentavalent Vaccine. The baseline for this indicator was based on the 2018 SMART survey for the original 12 states participating in the immunization plus component. The Baseline should be 53.5 if we reflect the current 15 states. The survey has not been conducted since 2019. Current Actual will be updated if SMART survey is Comments: repeated or source of data is changed at restructuring. The proxy source of data for this indicator the Multiple indicator cluster survey (MICS) indicates an increase from 36.5 to 54.6 between MICS 2016 and 2021, for the 12 states; and 38.4 to 58.3 for the same period for the current 15 states. IN01273983 Percentage girls ages (12-23) months vaccinated with third dose of Pentavalent Vaccine (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 42.80 42.80 42.80 64.40 IN01273985 ►Percentage of children ages (12-23) months vaccinated with third dose of Pneumococcal Vaccine (will be disaggregated by gender) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 46.60 46.60 46.60 63.30 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Percentage of children ages (12-23) months vaccinated with third dose of Pneumococcal Vaccine. This indicator will be disaggregated by gender once the dataset becomes available. Baseline was set using NDHS 2018 average for 12 in the immunization plus component. The indicator was not included in Comments: 2016/17 MICS, however MICS 2021 gives an average of 56.6 for the current 15 states and 52.8 in the original 12 states. IN01273986 ►Percentage of women (15-49) who had live births in the 2 years preceding the survey who were assisted by a skilled birth attendant during delivery (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/13/2023 Page 4 of 10 The World Bank Implementation Status & Results Report Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Value 45.10 45.10 45.10 52.60 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Percent of women (15-49) who had live births in the 2 years preceding the survey who were assisted by a skilled birth attendant during delivery. The baseline was based on NNHS (SMART) 2018. However SMART survey was last conducted in 2019. The proxy data from MICS suggests an Comments: increase from 51.3 to 56.7 between 2016 and 2021 for the 12 original states and 51.9 to 58.7 for the current 15 states in the same time period. IN01273988 ►Percentage of women (15-49) receiving a postnatal checkup within 2 days of delivery among respondents who had a birth in the 2 years preceding the survey (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 47.70 47.70 47.70 55.20 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Percentage of women (15-49) receiving a postnatal checkup within 2 days of delivery among respondents who had a birth in the 2 years preceding the survey. The baseline was based on NDHS 2018. There's been no repeat NDHS since then. Proxy data from MICS vary significantly from NDHS and Comments: should be considered with caution. MICS shows an increase from 1.7 in 2016 to 3.2 in 2021 for the original 12 states in component 2, and from 2 to 3.1 percent for the current 15 states in the same time period. To improve quality of malaria and immunization plus services IN01273981 ►Average Health Facility Quality of Care Score (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 34.30 34.30 34.30 59.30 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Average score of participating health facilities based on composite quality index. This is based on Comments: the NHFS 2016 results. No current data to update the result. Intermediate Results Indicators by Components 1. Malaria Control IN01273989 ►Percentage of pregnant women who received three or more doses of IPT during antenatal care (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 8.10 8.10 8.10 20.00 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Percentage of pregnant women who received three or more doses of IPT during antenatal care in Comments: malaria states. The baseline was based on 2018 NNHS (SMART) result of the original 6 states in the 6/13/2023 Page 5 of 10 The World Bank Implementation Status & Results Report Nigeria Improved Child Survival Program for Human Capital MPA (P167156) malaria component. Proxy data from the malaria indicator survey (MIS) shows an increase from 28.1 to 40.3 percent between 2015 and 2021. IN01273992 ►Percentage of Primary Health Facility Health Workers who have Knowledge of IMCI Key danger signs and main symptoms in malaria states (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.40 45.40 45.40 55.40 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Percentage Primary Health Facility Health Workers who have Knowledge of IMCI Key danger signs and main symptoms in malaria states. No recent National Health Facility Survey data. Actual current Comments: will be updated with the next survey that is expected in 2023. IN01273995 ►Percentage of children under 5 with fever in the last two weeks who had had blood taken from a finger or heel for testing in malaria control states (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 18.50 18.50 18.50 31.00 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Percentage of children under 5 with fever in the last two weeks who had had blood taken from a finger or heel for testing in malaria control states. No current data to update this indicator. A proxy Comments: source - MICS, show a marginal increase from 15 to 16 percent between 2016 and 2021. IN01273997 ►Percentage of public health facilities with safe disposal of sharps waste in malaria states (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 46.40 46.40 46.40 61.40 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Percentage of public health facilities with safe disposal of medical waste in malaria states. The baseline for this indicator was based on the National Health Facility Survey 2016. Indicator will be updated Comments: when the repeat survey is conducted in 2023. IN01273999 ►Percentage increase in performance framework score of federal and state PIUs in malaria states (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 50.00 50.00 Date 31-Dec-2019 12-Aug-2022 30-May-2023 31-Dec-2025 Comments: Percentage increase in performance framework score of NMEP and SMEPs in malaria states 2. Immunization Plus IN01273991 6/13/2023 Page 6 of 10 The World Bank Implementation Status & Results Report Nigeria Improved Child Survival Program for Human Capital MPA (P167156) ►Percentage of facilities receiving DFF with engagement of ward development committee for facility management (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 100.00 80.00 Date 31-Dec-2019 12-Aug-2022 29-May-2023 31-Dec-2025 Percentage of facilities receiving DFF with engagement of ward development committee for facility management Citizen Engagement Indicator: This CE indicator ensures that the community through the ward development committee has a voice in the management and oversight of the facilities being financed Comments: by the project. Evidence of engagement with WDC is confirmed for each facility as requirement for fund disbursement. IN01273994 ►Percentage of public health facilities with safe disposal of sharps waste in immunization plus states (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 26.50 26.50 26.50 41.50 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Percentage of public health facilities with safe disposal of sharps waste in immunization plus states. No recent National Health Facility Survey data. Actual current will be updated with the next survey Comments: that is expected in 2023. IN01273996 ►Percentage of children ages (12-23) months vaccinated with the 3rd dose of Pentavalent Vaccine in bottom two quintiles (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 18.40 18.40 18.40 49.20 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Percentage of children ages (12-23) months vaccinated with the 3rd dose of Pentavalent Vaccine in bottom two quintiles. The baseline for this indicator was based on the NDHS 2018. Actual current will be updated when the next survey is conducted or the results framework is changed at restructuring. Proxy Comments: data from MICS 2016 and MICS 2021 indicate an increase from 30.2 to 82.8 percent among children in the last two bottom quintiles IN01273998 ►Proportion of annual vaccine procurement expenditure released from government budgetary resources (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 28.00 28.80 55.00 60.00 Date 31-Dec-2019 12-Aug-2022 25-May-2023 31-Dec-2025 Comments: Proportion of annual vaccine procurement expenditure released from government budgetary resources IN01274000 ►Percentage increase in performance framework score of federal and state PIUs in immunization plus states (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/13/2023 Page 7 of 10 The World Bank Implementation Status & Results Report Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Value 0.00 0.00 50.00 50.00 Date 31-Dec-2019 12-Aug-2022 30-May-2023 31-Dec-2025 Percentage increase in performance framework score of NPHCDA and SPHCDAs in Immunization Plus Comments: States IN01274001 ►Primary Health Facility Health Workers’ Knowledge of IMCI Key danger signs and main symptoms in immunization plus states (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 48.00 48.00 48.00 58.00 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Percentage Primary Health Facility Health Workers who have Knowledge of IMCI Key danger signs and main symptoms in immunization plus states. The baseline for this indicator was based on the National Comments: Health Facility Survey 2016. Indicator will be updated when the repeat survey is conducted in 2023. IN01274002 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 10,873,941.00 8,000,000.00 Date 31-Dec-2019 12-Aug-2022 30-May-2023 31-Dec-2025 Data for reporting of this indicator is from the DHIS 2. The accuracy of the data at this point can not be ascertain. With the support from the IMPACT project, the Federal Ministry of Health will carry out activities Comments: to improve the quality of data from DHIS2 IN01274003 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 6,669,083.00 5,000,000.00 IN01274004 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 8,326,451.00 6,000,000.00 Date 31-Dec-2019 12-Aug-2022 30-May-2023 31-Dec-2025 IN01274005 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 2,547,490.00 2,000,000.00 Date 31-Dec-2019 12-Aug-2022 30-May-2023 31-Dec-2025 6/13/2023 Page 8 of 10 The World Bank Implementation Status & Results Report Nigeria Improved Child Survival Program for Human Capital MPA (P167156) 3. Knowledge for Change IN01273990 ►Semi-annual nationwide LQAS surveys conducted and disclosed publicly (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3.00 4.00 10.00 Date 31-Dec-2019 12-Aug-2022 01-Jun-2023 31-Dec-2025 Comments: Semi-annual nationwide LQAS surveys conducted and disclosed publicly IN01273993 ►Percentage of facilities where a copy of the checklist was left at the facility for the most recent ISS visit (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 16.20 16.20 16.20 41.20 Date 31-Dec-2019 12-Aug-2022 12-Aug-2022 31-Dec-2025 Percentage of facilities where a copy of the checklist was left at the facility for the most recent ISS visit in malaria and immunization plus states. The baseline for this indicator was based on the National Comments: Health Facility Survey 2016. Indicator will be updated when the repeat survey is conducted in 2023. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P167156 IDA-65390 Effective USD 650.00 650.00 0.00 147.90 480.01 24% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P167156 IDA-65390 Effective 18-Feb-2020 18-Sep-2020 17-Feb-2021 31-Dec-2025 31-Dec-2025 Cumulative Disbursements 6/13/2023 Page 9 of 10 The World Bank Implementation Status & Results Report Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 6/13/2023 Page 10 of 10