The World Bank Implementation Status & Results Report Transforming Health Systems for Universal Care (P152394) Transforming Health Systems for Universal Care (P152394) EASTERN AND SOUTHERN AFRICA | Kenya | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2016 | Seq No: 16 | ARCHIVED on 29-Sep-2023 | ISR57119 | Implementing Agencies: Ministry of Health, Republic of Kenya Key Dates Key Project Dates Bank Approval Date: 15-Jun-2016 Effectiveness Date: 04-Jul-2016 Planned Mid Term Review Date: 11-Mar-2019 Actual Mid-Term Review Date: 25-Mar-2019 Original Closing Date: 30-Sep-2021 Revised Closing Date: 30-Sep-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is to improve utilization and quality of primary health care services with a focus on reproductive, maternal, newborn, child, and adolescent health services. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) The project development objective is to improve utilization and quality of primary health care services with a focus on reproductive, maternal, newborn, child and adolescent health services and to provide immediate and effective response to an eligible crisis or emergency . Components Table Name Improving Primary Health Care Results:(Cost $141.00 M) Strengthening Institutional Capacity:(Cost $28.70 M) Contingency Emergency Response:(Cost $10.00 M) Cross-county and Intergovernmental Collaboration, and Project Management:(Cost $11.40 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The Project Development Objective aimed to improve utilization and quality of primary health care services with a focus on reproductive, maternal, newborn, child and adolescent health services and to provide immediate and effective response to an eligible crisis or emergency. At the time of the July 2023 implementation support mission, the overall rating for the project is Moderately Satisfactory with substantial achievement with a 9/29/2023 Page 1 of 8 The World Bank Implementation Status & Results Report Transforming Health Systems for Universal Care (P152394) substantial ratings for improving utilization of primary health care services and quality of primary health care services and a high rating for the response to an eligible crisis or emergency. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High Substantial Substantial Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and High High High Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Low Moderate Moderate Stakeholders Substantial Substantial Substantial Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improved utilization and quality of primary health care services IN01318466 ►Children immunized with the third dose of Pentavalent (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 79.50 82.50 84.80 84.00 Date 31-Dec-2015 21-Feb-2023 30-Jun-2023 30-Sep-2023 Target surpassed: The annual achievement of 84.8 percent surpassed the target of 84.0 percent. The improvement is consistent with the data reported in the KDHS (88.3 percent 2014 to 89.2 percent 2022). Comments: While this indicator measures utilization of PHC services, it also highlights progress made in quality of care (e.g., timeliness, availability of skilled service providers and commodities). IN01318468 ►Pregnant women attending at least four ANC visits (Percentage, Custom) 9/29/2023 Page 2 of 8 The World Bank Implementation Status & Results Report Transforming Health Systems for Universal Care (P152394) Baseline Actual (Previous) Actual (Current) End Target Value 39.70 50.50 51.90 52.00 Date 31-Dec-2015 21-Feb-2023 30-Jun-2023 30-Sep-2023 Target achieved: The annual achievement of 51.9 percent nearly achieved the target of 52.0 percent. Due to the surpassed achievement from January - June 2023 (52.6 percent) and rounding of decimal points, the task team recommends that this indicator achieved its target. The improvement is consistent Comments: with the data reported in the KDHS (58 percent 2014 to 66.0 percent 2022). While this indicator measures utilization of PHC services, it also highlights progress made in quality of care (e.g., timeliness, availability of skilled service providers and medical supplies needed for ANC). IN01318469 ►Births attended by skilled health personnel (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 57.00 75.80 75.50 67.00 Date 31-Dec-2015 21-Feb-2023 30-Jun-2023 30-Sep-2023 Target surpassed: The annual achievement of 75.5 percent surpassed the target of 67.0 percent. The improvement is consistent with data reported in the KDHS (66 percent 2014 to 89 percent in 2022). While this indicator measures utilization of PHC services, it also highlights progress made in quality of care (e.g., Comments: availability of skilled service providers and medical supplies needed for institutional deliveries). In addition to the project, the government’s programs – Linda Mama and Free Maternity contributed to the substantial improvement of this indicator. IN01318470 ►Women between the ages of 15-49 years currently using a modern FP method (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 47.80 37.00 37.00 52.00 Date 31-Dec-2015 21-Feb-2023 30-Jun-2023 30-Sep-2023 Based on the KHIS data, this indicator is not achieved. However, the task team has been extensively documenting in the project aide memoires that the measurement of this indicator in KHIS does not adequately measure the mix of family planning methods as it is biased against measuring long-acting FP methods (which is increasingly the preferred method), and the definition of the indicator remains under review by the MoH and FP Technical Working Group. Therefore, while the KHIS reports modern contraceptive prevalence rate (mCPR) at 36.7 percent, there is robust survey data that show a clear upward trend. The 2022 KDHS reports an increase from 53 percent in 2014 to 57 percent in 2022. This is Comments: consistent with the trends observed in the PMA survey where mCPR increased from 53 percent in 2014 to 61 percent in 2021 among married and from 42 percent to 46 percent in the same time period among all women of reproductive age. Based on this complementary data and the further analysis provided in the February 2023 aide memoire (annex 7), the task team recommends that this indicator be considered as substantially achieved. While this indicator measures utlization of PHC services, it also highlights progress made in quality of care (e.g., availability of FP commodities). IN01318471 ►Inspected facilities meeting safety standards (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 30.00 22.00 50.00 9/29/2023 Page 3 of 8 The World Bank Implementation Status & Results Report Transforming Health Systems for Universal Care (P152394) Date 31-Dec-2015 21-Feb-2023 30-Jun-2023 30-Sep-2023 Achievement to be assessed at the close of the project: This indicator measures quality of care. Due to delays in scale up and implementation of the facility inspections as well as challenges in migrating the inspection tool from paper-based to electronic, there is a backlog of data that is being assessed and Comments: reported into the electronic platform. Therefore, achievement of this indicator will be assessed at the close of the project. Nonetheless, considering the implementation challenges, it is likely that the achievement will not be higher than partially achieved. IN01318472 ►Pregnant women attending ANC supplemented with IFA (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 31.00 75.30 80.30 73.00 Date 31-Dec-2015 21-Feb-2023 30-Jun-2023 30-Sep-2023 Target surpassed: The annual achievement of 80.3 percent surpassed the target of 73.0 percent. The improvement is consistent with data reported in the KDHS (69.2 percent 2014 to 90.2 percent 2022). Comments: While this indicator measures quality of care, it also highlights improvements in utilization of PHC services. Provision of immediate and effective response to an eligible crisis or emergency IN01318467 ►Reported suspected cases of COVID-19 cases investigated based on national guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 80.00 Date 18-Mar-2020 21-Feb-2023 30-Jun-2023 31-Dec-2021 Target achieved: This indicator measures the government's response to the COVID-19 pandemic. Comments: Overall Comments PDO The data reported is as of June 30, 2023 and may change by the project's closing date on September 30, 2023. Intermediate Results Indicators by Components Component 1: Improved primary health care results IN01318484 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 14,740,155.00 14,740,155.00 10,060,000.00 Date 29-Sep-2016 21-Feb-2023 30-Jun-2023 30-Sep-2023 9/29/2023 Page 4 of 8 The World Bank Implementation Status & Results Report Transforming Health Systems for Universal Care (P152394) Target surpassed: This IRI is mapped to utilization of PHC services. Comments: IN01318485 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 7,298,785.00 7,298,785.00 5,400,000.00 Date 29-Sep-2016 21-Feb-2023 30-Jun-2023 30-Sep-2023 IN01318486 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 7,441,370.00 7,441,370.00 4,660,000.00 Date 29-Sep-2016 21-Feb-2023 30-Jun-2023 30-Sep-2023 Component 2: Strengthened institutional capacity IN01318473 ►Facilities inspected for safety standards (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,446.00 3,981.00 1,635.00 Date 11-Mar-2016 21-Feb-2023 30-Jun-2023 30-Sep-2023 Target surpassed: This IRI is mapped to quality of care. Comments: IN01318476 ►Reports submitted to DHIS in a timely manner. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 88.80 98.00 98.50 98.00 Date 31-Dec-2015 21-Feb-2023 30-Jun-2023 30-Sep-2023 Target surpassed: This IRI is mapped to quality of care. Comments: IN01318478 ►Births registered within 6 months of occurrence (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.90 86.20 80.60 80.00 Date 31-Dec-2015 21-Feb-2023 30-Jun-2023 30-Sep-2023 Target surpassed: This IRI is mapped to quality of care. Comments: IN01318481 ►RMNCAH related operations research completed to inform policy/strategy (Number, Custom) 9/29/2023 Page 5 of 8 The World Bank Implementation Status & Results Report Transforming Health Systems for Universal Care (P152394) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 1.00 2.00 Date 11-Mar-2016 21-Feb-2023 30-Jun-2023 30-Sep-2023 Target on track to be achieved: This IRI is mapped to quality of care. Comments: IN01318482 ►A benefit package developed, costed, and disseminated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 1.00 Date 11-Mar-2016 21-Feb-2023 30-Jun-2023 30-Sep-2023 Target achieved: This IRI is mapped to quality of care. Comments: IN01318483 ►Lessons learned from UHC Phase I documented and disseminated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 20-Jun-2019 21-Feb-2023 30-Jun-2023 31-Dec-2019 Target achieved: This IRI is mapped to quality of care. Comments: Component 3: Cross-county/intergovernmental collaboration and project management IN01318474 ►Functional community units (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 302.00 7,794.00 7,794.00 5,331.00 Date 31-Dec-2015 21-Feb-2023 30-Jun-2023 30-Sep-2023 Target surpassed: This IRI is mapped to utilization of PHC services. Comments: IN01318477 ►Grievances registered related to delivery of project benefits that are addressed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 80.00 Date 31-Dec-2015 21-Feb-2023 30-Jun-2023 30-Sep-2023 Target surpassed: This IRI is mapped to quality of care. Comments: IN01318479 9/29/2023 Page 6 of 8 The World Bank Implementation Status & Results Report Transforming Health Systems for Universal Care (P152394) ►Implementing entities submitting the annual FM and technical report on time (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 95.00 Date 11-Mar-2016 21-Feb-2023 30-Jun-2023 30-Sep-2023 Target surpassed: This IRI is mapped to quality of care. Comments: Component 4: Contingency Emergency Response IN01318475 ►Designated laboratories with COVID diagnostic equipment (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 41.00 41.00 8.00 Date 18-Mar-2020 21-Feb-2023 30-Jun-2023 31-Dec-2021 Target surpassed: This IRI is mapped to the government's response to the COVID-19 pandemic. When the COVID-19 Health Emergency Response Project (CHERP, P173820) and CERC were designed, there Comments: were only 8 designated laboratories for COVID-19 testing. The number of laboratories equipped with diagnostic equipment has since increased to 41 laboratories. IN01318480 ►Vulnerable and marginalized communities reached in their indigenous language (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 80.00 Date 18-Mar-2020 21-Feb-2023 21-Feb-2023 31-Dec-2021 Target surpassed: This IRI is mapped to the government's response to the COVID-19 pandemic. Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P152394 IDA-58360 Effective USD 150.00 150.00 0.00 140.91 6.90 95% P152394 TF-A2561 Closed USD 40.00 40.00 0.00 39.87 0.13 100% P152394 TF-A2792 Closed USD 1.10 0.95 0.15 0.95 0.00 100% 9/29/2023 Page 7 of 8 The World Bank Implementation Status & Results Report Transforming Health Systems for Universal Care (P152394) Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P152394 IDA-58360 Effective 15-Jun-2016 04-Jul-2016 29-Sep-2016 30-Sep-2021 30-Sep-2023 P152394 TF-A2561 Closed 15-Jun-2016 04-Jul-2016 29-Sep-2016 30-Sep-2021 30-Jun-2023 P152394 TF-A2792 Closed 15-Jun-2016 04-Jul-2016 04-Jul-2016 30-Jun-2020 31-May-2022 Cumulative Disbursements Restructuring History Level 2 Approved on 24-Jun-2019 ,Level 2 Approved on 31-Jan-2020 ,Level 2 Approved on 20-Oct-2020 ,Level 2 Approved on 26-Mar-2021 ,Level 2 Approved on 15-Sep-2021 ,Level 2 Approved on 26-May-2023 Related Project(s) P174772-Additional Financing for THS-UCP 9/29/2023 Page 8 of 8