The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) WESTERN AND CENTRAL AFRICA | Central African Republic | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2022 | Seq No: 3 | ARCHIVED on 16-Oct-2023 | ISR56767 | Implementing Agencies: Central African Republic, Ministry of Finance and Budget, Ministry of Health and Population, Central African Republic Key Dates Key Project Dates Bank Approval Date: 03-Jun-2022 Effectiveness Date: 15-Sep-2022 Planned Mid Term Review Date: 31-Dec-2024 Actual Mid-Term Review Date: Original Closing Date: 30-Sep-2027 Revised Closing Date: 30-Sep-2027 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase utilization of quality essential health services, especially for women and children, in targeted areas in the Central African Republic. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Supporting Essential Health Service Delivery:(Cost $36.00 M) Component 2: Strengthening Health System Performance and Preparedness:(Cost $32.00 M) Component 3: Project Management, Coordination and Monitoring & Evaluation (M&E):(Cost $2.00 M) Component 4: Contingent Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The project development objective is to increase utilization of quality essential health services, especially for women and children, in targeted areas in the Central African Republic. The project has progressed well with major contracts signed and teams in place after one year of effectiveness (September 2022). Despite some delays, disbursement has improved. However, the project suffers from lack of availability of data and requires that the verification for performance- based financing, as well as quality assessments need to resume as soon as possible. 10/16/2023 Page 1 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Supporting Essential Health Service Delivery IN01308874 ►Children who have received 3 doses of Pentavalent vaccine (Penta3) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 43,059.00 47,507.00 65,882.00 58,120.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Number of children who have received third doses of Pentavalent vaccine from staff of facilities targeted by the Project. Actual represents the sum of previous 4 quarters (Q3/Q4 2022 and Q1/Q2 2023). As verification for PBF Comments: has not happened during this period, we are using declared data from HMIS as proxy. Data will be updated after the first round of PBF verification (Q1 2024). This indicator is non-cumulative and targets are yearly targets. Baseline represents annual data of 2021. IN01308941 ►Deliveries attended by skilled health personnel (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 10/16/2023 Page 2 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) Value 82,373.00 87,119.00 72,396.00 90,060.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Number of deliveries attended by skilled health personnel in facilities (including facility based dutocic deliveries, dystocic deliveries and c-sections) targeted by the project. Actual represents the sum of previous 4 quarters (Q3/Q4 2022 and Q1/Q2 2023). As verification for PBF has not happened during this period, we are using declared data from HMIS as proxy. Data will be Comments: updated after the first round of PBF verification (Q1 2024). This indicator is non-cumulative, and targets are yearly targets. Baseline represents annual data of 2021. IN01308943 ►Modern contraceptive services received by women and adolescents (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 104,053.00 96,702.00 109,526.00 125,128.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Number of contraceptive services (oral contraceptives, injections, intrauterine devices and implants) delivered in the previous 4 quarters in facilities targeted by the Project. Actual represents the sum of previous 4 quarters (Q3/Q4 2022 and Q1/Q2 2023). As verification for PBF has not happened during this period, we are using declared data from HMIS as proxy. Data will be updated after the first round of PBF verification (Q1 2024). There was an error in the actual (previous) of the long-term which had the same value as short-term Comments: contraceptive services. Targets for long-term is also being revised and will be formalized in the next restructuring. This indicator is non-cumulative, and targets are yearly targets. Baseline represents annual data of 2021. IN01308944 Modern contraceptive services received by women and adolescents – short-term (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 102,112.00 94,381.00 107,188.00 111,640.00 Date 01-Mar-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 IN01308945 Modern contraceptive services received by women and adolescents – long-term and permanent (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1,940.00 94,381.00 2,338.00 3,509.00 Date 01-Mar-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Strengthening Health System Performance and Preparedness IN01308875 ►Availability of tracer drugs at health centers in targeted districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 76.00 85.00 82.00 85.00 10/16/2023 Page 3 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Average of the percentage of tracer drugs (as defined in the PBF quality assurance tool) available in each health centre for the previous 4 quarters where data available (Q3/Q4 2021 and Q1/Q2 2022) in facilities targeted by the Project. Comments: Actuals only reflects an average of 5 districts (out of 15 target districts) as quality assessment was not fully conducted during the reporting period. Once quality assessment completed (Q4 2023) this will be updated. IN01308942 ►Average quality score of health centers in targeted districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 55.00 56.00 56.60 80.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Average of PBF quality scores for the previous four quarters where data available (Q3/Q4 2021 and Q1/Q2 2022) in facilities targeted by the Project. Actuals only reflects an average of 5 districts (out of 15 target districts) as quality assessment was not Comments: fully conducted during the reporting period. Once quality assessment completed (Q4 2023) this will be updated. Intermediate Results Indicators by Components 1. SUPPORTING ESSENTIAL HEALTH SERVICE DELIVERY IN01308953 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 199,914.00 1,219,720.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Baseline revised to 0 to align with CRI definition. Actuals represents cumulative number since project effectiveness. Comments: As verification for PBF has not happened during this period, we are using declared data from HMIS as proxy. Data will be updated after the first round of PBF verification (Q1 2024). IN01308956 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 0.00 179,614.00 821,720.00 IN01308958 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 72,396.00 434,650.00 10/16/2023 Page 4 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 IN01308960 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 62,444.00 350,620.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 IN01308961 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 65,074.00 434,450.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 1.1: Increasing Health Service Utilization and Quality through PBF IN01308946 ►Pregnant women who have attended 4 antenatal care visits (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 38,907.00 44,468.00 47,084.00 66,710.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Number of pregnant women who have attended a fourth antenatal care visit in facilities targeted by the Project. Actual represents the sum of previous 4 quarters (Q3/Q4 2022 and Q1/Q2 2023). As verification for PBF has not happened during this period, we are using declared data from HMIS as proxy. Data will be Comments: updated after the first round of PBF verification (Q1 2024). This indicator is non-cumulative, and targets are yearly targets. Baseline represents annual data of 2021. IN01308954 ►Patients under the Free Health Services (Gratuité Ciblé) scheme who report receiving their service and medication at no charge (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 81.00 81.00 81.00 90.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Percentage of eligible patients in the PBF community survey who report not having paid any charges for services or medication. Comments: Updated data not yet available as Community Satisfaction Survey has not been conducted. Data to be compiled by end December 2023. IN01308957 ►Facilities receiving performance payments on time (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 10/16/2023 Page 5 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) Value 60.00 60.00 76.60 80.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Percentage of facilities eligible for performance payments that received them in accordance with the timelines set out in the PBF Manual. Comments: As PBF verification did not happen during the reporting period, the actuals represents an advance transferred to health facilities. IN01308959 ►Quality satisfaction score of beneficiaries for health services in district hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 56.00 56.60 80.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Last available data is from Q4 2022. Data is extrapolated from 5 districts out of 15 as quality assessment was only done in these 5 districts during the reporting period. Update once assessment is completed (end Comments: December 2023). 1.2 Strengthening community-based essential health service delivery IN01308947 ►People referred to health facilities by community workers (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 76,496.00 73,150.00 73,150.00 97,550.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2023 30-Sep-2027 Number of patient referrals by community health workers to facilities (with proof of receipt at the facility) targeted by the Project. Indicator could not be updated due to lack of completeness in HMIS (data only captured for one of the four quarters). This indicator is non-cumulative and targets are yearly targets. Baseline represents annual data of 2021. Comments: 1.3: Providing Holistic Support to GBV Survivors IN01308950 ►District hospitals with integrated GBV services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 5.00 5.00 15.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Number of hospitals supported by the Project that have a psychosocial agent and staff trained in GBV services. Preparatory activities have started for the scale up of this component to the additional 10 target Comments: districts, but is not yet fully operational. 10/16/2023 Page 6 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) 2. STRENGTHENING HEALTH SYSTEM PERFORMANCE AND PREPAREDNESS IN01308952 ►NHDP/Investment Case performance reports discussed at quarterly meetings of the Comite de Pilotage Unique (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 15.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Cumulative number of quarters in which National Health Development PLan and/or Investment Case performance reports were presented and discussed at a meeting of the country platform (Comité de Comments: Pilotage Unique). Reports were not compiled in time but the data will be updated once this is done. 2.2: Upgrading Hospitals to Improve Domestic Diagnostic and Treatment Capacity IN01308949 ►Number of hospitals scoring 80% or higher on the 'diagnostic capacity' components of the PBF quality assurance checklist (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 12.00 Date 01-Feb-2022 31-Jan-2023 31-Jan-2023 30-Sep-2027 Number of hospitals scoring an average of 80% or higher for the new 'diagnostic capacity' sub-score of the PBF quality checklist for hospitals. Data not yet available as quality assessment has not taken place. Comments: Once quality assement completed this indicator will be updated (end December 2023). 2.3: Implementation Support for Key Health Sector Reforms IN01308951 ►Number of additional health professionals employed full-time in health facilities in targeted districts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 264.00 326.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Number of health professionals employed in facilities supported by the Project as reported in the latest quarterly PBF submissions. The team proposes to drop the initial wording "additional" as this is not Comments: tracked in the PBF data. No availability of gender disaggregated data for the reporting period. IN01308955 Number of health professionals employed full-time in health facilities in targeted districts - female (disaggregation) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 190.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 10/16/2023 Page 7 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) 2.4: Integrating Pandemic Preparedness in Health System Strengthening IN01308948 ►CHWs trained on epidemic surveillance and preparedness (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1,650.00 Date 01-Feb-2022 31-Jan-2023 31-Aug-2023 30-Sep-2027 Cumulative number of community health workers (CHWs) trained on epidemic surveillance and preparedness with support from the project in targeted districts. Comments: Training is just being rolled out so data not yet available. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P177003 IDA-E0480 Effective USD 58.00 58.00 0.00 7.14 48.24 13% P177003 TF-B8319 Effective USD 12.00 12.00 0.00 1.12 10.88 9.4% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P177003 IDA-E0480 Effective 03-Jun-2022 28-Jun-2022 15-Sep-2022 30-Sep-2027 30-Sep-2027 P177003 TF-B8319 Effective 03-Jun-2022 28-Jun-2022 15-Sep-2022 30-Jun-2025 30-Jun-2025 Cumulative Disbursements 10/16/2023 Page 8 of 9 The World Bank Implementation Status & Results Report CAR Health Service Delivery and System Strengthening Project (SENI-Plus) (P177003) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 10/16/2023 Page 9 of 9