The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Mozambique Primary Health Care Strengthening Program (P163541) EASTERN AND SOUTHERN AFRICA | Mozambique | Health, Nutrition & Population Global Practice | Requesting Unit: AECS2 | Responsible Unit: HAEH1 IBRD/IDA | Program-for-Results Financing | FY 2018 | Team Leader(s): Humberto Albino Cossa Seq No: 11 | ARCHIVED on 25-Oct-2023 | ISR56628 | Created by: Nilsa Ricardina Joao Come on 30-May-2023 | Modified by: Sara Alexandra Dias Paulino Saija on 01-Sep-2023 Program Development Objectives PDO Table Program Development Objective (from Program Appraisal Document) The Program Development Objective is to improve the utilization and quality of reproductive, maternal, child and adolescent health and nutrition services, particularly in underserved areas. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Implementation Status and Key Decisions Overall, notable improvement was verified during the field visits and meetings held in May 2023, and advances in implementation were particularly noted in the utilization of reproductive health services (coverage of family planning and institutional deliveries), human resources, service quality and in the disbursement of grants to 90% of inpatient primary health care units in the three most needy provinces. Program ratings for implementation progress, DLI achievement, and progress towards achieving the PDO are moderately satisfactory. Important changes were noted in many areas of the Program; nevertheless, persistent challenges are hindering the full achievement of the Program’s potential. These include: (i) limited coverage of the nutrition intervention package (DLI 4) which remains below the target albeit a slight change achieved with support from an NGO hired to expand the coverage, mostly related to the lack of supplies for the work of the community health workers (APEs), and (ii) the APE performance/quality study not taken place yet – this will result in an amount of $3.5 million not disbursed before the closing of the Program; The team will continue to support the Ministry of Health in the remaining 4 months of implementation, and discussions have started regarding the preparation of the Implementation Completion and Results Report. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P163541 IDA-D2650 Effective USD 80.00 80.00 0.00 77.06 2.12 97% P163541 TF-A6152 Effective USD 25.00 25.00 0.00 22.15 2.85 89% P163541 TF-A9398 Effective USD 82.50 82.50 0.00 62.69 19.81 76% P163541 TF-B3368 Effective USD 7.00 7.00 0.00 6.27 0.73 90% 10/25/2023 Page 1 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) P163541 TF-B4481 Effective USD 8.70 8.70 0.00 5.82 2.88 67% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P163541 IDA-D2650 Effective 20-Dec-2017 02-Mar-2018 18-Apr-2018 31-Dec-2022 31-Dec-2023 P163541 TF-A6152 Effective 20-Dec-2017 02-Mar-2018 18-Apr-2018 31-Dec-2021 31-Dec-2023 P163541 TF-A9398 Effective 28-Feb-2019 21-Mar-2019 21-Mar-2019 31-Dec-2023 31-Dec-2023 P163541 TF-B3368 Effective 01-Oct-2020 16-Oct-2020 16-Oct-2020 31-Dec-2023 31-Dec-2023 P163541 TF-B4481 Effective 21-May-2021 21-May-2021 21-May-2021 30-Jun-2021 31-Dec-2023 DLI Disbursement Achievement Disbursed amount in Disbursement % for DLI ID DLI Type Description Coc DLI Amount Status Coc DLI Loan: TFA6152-001 Recipient increase the % Partially 1 Regular USD 6,000,000.00 4,937,800.00 82 % of institutiona Achieved Recipient increased % of Partially 2 Regular USD 2,800,000.00 1,800,000.00 64 % secondary schoo Achieved Recipient increased couple Partially 3 Regular USD 700,000.00 689,871.00 99 % years of prot Achieved Recipient increased % Partially 4 Regular USD 3,700,000.00 560,000.00 15 % childreen between Achieved Recipient increased Partially 5 Regular USD 2,900,000.00 1,900,000.00 66 % Domestic Heatlh Expe Achieved Recipient increased nr Partially 7 Regular USD 900,000.00 800,000.00 89 % Technical health Achieved Recipient demostrated 8 Regular USD 2,500,000.00 Fully Achieved 2,500,000.00 100 % district/ rural ho Recipient demostrated Partially 9 Regular USD 1,700,000.00 1,500,000.00 88 % rural health cente Achieved Recipient increased % of Partially 11 Regular USD 3,800,000.00 3,713,823.00 98 % deaths certifie Achieved Loan: IDAD2650-001 Recip incrsd no of distr of Partially 1 Regular XDR 6,840,000.00 6,261,094.00 92 % the 42 laggi Achieved Recipient incr % sec&tech Partially 2 Regular XDR 3,847,500.00 1,710,000.00 44 % sch offering s Achieved Recip increased couple Partially 3 Regular XDR 2,992,500.00 2,980,582.00 100 % years of protecti Achieved Recipient increased % Partially 4 Regular XDR 5,985,000.00 2,422,500.00 40 % children 0-24 Mon Achieved 10/25/2023 Page 2 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Recipient increased Partially 5 Regular XDR 6,127,500.00 4,880,625.00 80 % domestic health exp Achieved Recipient increased health 6 Regular XDR 2,850,000.00 Not Achieved 0.00 expenditures Recipient increased nr Partially 7 Regular XDR 5,058,750.00 4,845,000.00 96 % technical health Achieved Recipient district/rural 8 Regular XDR 6,555,000.00 Fully Achieved 6,555,000.00 100 % hospitals Recipient rural health 9 Regular XDR 7,338,750.00 Fully Achieved 7,338,750.00 100 % centers in priori Recipient increased no 10 Regular XDR 5,343,750.00 Fully Achieved 712,500.00 13 % Trained active CH % of deaths in elig health Partially 11 Regular XDR 4,061,250.00 3,475,948.00 86 % facilities ce Achieved Loan: TFA9398-001 Recipient increase the % Partially 1 Regular USD 5,600,000.00 5,350,000.00 96 % of institutiona Achieved Recipient increased % of Partially 2 Regular USD 7,800,000.00 5,300,000.00 68 % secondary schoo Achieved Recipient increased couple Partially 3 Regular USD 14,600,000.00 11,991,954.00 82 % years of prot Achieved Recipient increased % Partially 4 Regular USD 6,900,000.00 1,273,333.00 18 % childreen between Achieved Recipient increased 5 Regular USD 2,000,000.00 Fully Achieved 1,500,000.00 75 % Domestic Heatlh Expe Recipient increased health 6 Regular USD 3,000,000.00 Not Achieved 0.00 expenditures Recipient increased nr Partially 7 Regular USD 6,000,000.00 3,900,000.00 65 % Technical health Achieved Recipient demostrated Partially 8 Regular USD 9,800,000.00 6,800,000.00 69 % district/ rural ho Achieved Recipient demostrated Partially 9 Regular USD 12,000,000.00 10,200,000.00 85 % rural health cente Achieved Recipient increased % of Partially 10 Regular USD 3,000,000.00 2,963,281.00 99 % deaths certifie Achieved Recipient increased % Partially 11 Regular USD 7,300,000.00 5,166,723.00 71 % deaths certified d Achieved Recipient increased 12 Regular USD 4,500,000.00 Not Achieved 0.00 maternal & rep healt Loan: TFB3368-001 Recipient increased % of Partially 4 Regular USD 1,000,000.00 266,667.00 27 % children betwee Achieved Recipient increased No. of 10 Regular USD 6,000,000.00 Fully Achieved 5,999,999.80 100 % APEs 10/25/2023 Page 3 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Loan: TFB4481-001 The Recip has increased 7 Regular USD 2,000,000.00 Fully Achieved 2,000,000.00 100 % the No of Techi The Recip has increased 8 Regular USD 1,000,000.00 Fully Achieved 1,000,000.00 100 % the No of distri Recipient increased % of Partially 2 Regular USD 1,300,000.00 500,000.00 38 % secondary schoo Achieved Recipient increased couple 3 Regular USD 800,000.00 Not Achieved 0.00 years of prot Recipient increased No. of 9 Regular USD 1,100,000.00 Not Achieved 0.00 health center Recipient increased No. of Partially 10 Regular USD 2,500,000.00 2,316,404.00 93 % Active CHWs Achieved Program Action Plan Action Description The Program Operations Manual shall be adopted by the Recipient in a manner satisfactory to the Association. Source DLI# Responsibility Timing Timing Value Status Ministry of Health Technical Due Date 30-Jun-2019 Completed (MOH) - DPC Completion Measurement Approved POM Comments The Program Management Unit (PMU) shall be assembled with a Terms of Reference and composition satisfactory to Action Description the Association (including experienced fiduciary personnel). Source DLI# Responsibility Timing Timing Value Status Technical MOH - DPC Due Date 29-Jun-2018 Completed Completion Measurement PMU ToR Comments IC/PES Alignment: (i) Annual discussions on the analysis of spending alignment with the Investment Case's priorities Action Description led by MISAU's focal point. Source DLI# Responsibility Timing Timing Value Status MISAU (DAF and Fiduciary Systems Recurrent Yearly In Progress DPC) Completion Measurement Analysis and discussions held on IC spending alignment as part of the Balanço do PES in Q1 annually. Analysis is supported through (1) an ASA, and will be updated with the Investment Case final evaluation, and (2) Comments resource mapping and expenditure tracking exercises. 10/25/2023 Page 4 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) IC/PES Alignment: (ii) Provincial Program Contracts reviewed and updated annually with PES, including Action Description disaggregated DLI and results framework indicators. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems DPC Recurrent Yearly In Progress Completion Measurement Provincial Program Contracts updated annually. Comments Program Contracts were completed and shared, but require updating. Annual accounts of the health Economic and Social Plan (PES) audited within 12 months after the end of the fiscal Action Description year by the Administrative Tribunal; Resulting action plan produced, implemented, and reported on annually. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MOH -DAF Recurrent Yearly In Progress (i) Audit Report Completion Measurement (ii) Report on Action Plan implementation The 2019 Financial Audit was provided per the revised deadline and action plans are under implementation. The Comments 2020 Financial Audit was submitted with a delay of four months and is under review by the Bank. Annual procurement review of PES within 12 months of the FY's end by an independent firm, covering regulatory Action Description compliance, performance, and VFM; Action plans implemented and reported on; Remedies against ineligible expenditures and misprocurement. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MISAU & WB Recurrent Yearly In Progress (i) Audit Report (n-1) Completion Measurement (ii) Report on Action Plan implementation Procurement Reviews covering the entire health sector were finalized for 2016, 2017, 2018, and 2019 with action Comments plans under implementation. The review for 2020 was submitted. Missing information was requested. A final version will be sent by June 30 Annual updates on the implementation of the medium-term capacity development plan for the fiduciary staff at Action Description central, provincial, and district levels, including for ADUS. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MISAU (DAF) Recurrent Yearly In Progress Completion Measurement Annual report on the implementation of the capacity development plan. Comments Training plan developed and under implementation. 10/25/2023 Page 5 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) A roll-out plan developed to implement direct facility financing (ADUS), including training on the Financial Action Description Management Manual and disbursement method for each facility. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems DLI 8 MISAU Due Date 31-Jan-2021 In Progress Completion Measurement Roll-out plan for ADUS implementation. The roll-out was implemented in 297 health centers and 34 district hospitals in 2021, to be expanded to over 400 Comments health centers and all district hospitals in 2022. The ADUS manual is also being revised to include non-performance based financing. An Environmental Health Training Plan (including the EIA process, Waste Management, and Infection Prevention and Action Description Control) and a monitoring tool developed and updated semi-annually. Source DLI# Responsibility Timing Timing Value Status Environmental and Social DSA Recurrent Semi-Annually In Progress Systems Semi-annual updates on the implementation of the Environmental Health Training Plan and Monitoring Tool, including Completion Measurement semi-annual scorecard results, submitted to the World Bank. Comments Plan and monitoring tool developed and under implementation. Gender and socio-cultural responsiveness (I): Engagement of a social development specialist to: (i) provide oversight Action Description for gender and socio-cultural sensitivity in the sector; (ii) lead the review and enhancement of complaint handling mechanisms Source DLI# Responsibility Timing Timing Value Status Environmental and Social MISAU Due Date 29-Mar-2019 Completed Systems PAP IR Completion Measurement ToR developed and agreed with the Bank Social Development Specialist engaged Comments Gender and socio-cultural responsiveness (II): Ensure approaches to gender and socio-cultural sensitivity are Action Description reflected in the curriculum and training of community health workers and health staff and supported by appropriate materials. Source DLI# Responsibility Timing Timing Value Status MISAU DRH, DSNP Environmental and Social and MOH's Gender Recurrent Continuous In Progress Systems Unit Completion Measurement PAP IR; Curriculum; 10/25/2023 Page 6 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Training materials available at health centers and district/rural hospitals; and Number of trained staff in general and per province. The guiding material has been developed, reproduced, and distributed, and trainings were initiated. Additional training Comments and support packages are under development. A three-year plan identifying and addressing gaps and needs for improving the health system's GRM developed and Action Description implemented, including clear flows of information, accountability, and triage mechanisms. Source DLI# Responsibility Timing Timing Value Status Environmental and Social MOH (DNSP, Recurrent Yearly In Progress Systems DNAM) PAP IR Completion Measurement Annual reporting on GRM strengthening and results on nature and number of complaints registered and resolved. GRM strengthening mechanisms are implemented through health user desks, and reports are produced. Further Comments technical assistance is to be provided to strengthen systems for triage, monitoring, and response from different entry points. Action Description CMAM to retain a Pharmaceutical Waste Management specialist at all times during the duration of the program. Source DLI# Responsibility Timing Timing Value Status Environmental and Social CMAM Recurrent Continuous In Progress Systems Completion Measurement Pharmaceutical Waste Management Specialist hired and retained. Comments An annual national report on pharmaceutical waste management produced by CMAM based on terms of reference Action Description agreed with the World Bank Source DLI# Responsibility Timing Timing Value Status Environmental and Social CMAM Recurrent Yearly In Progress Systems Completion Measurement Annual reports on pharmaceutical waste management. Comments Annual report provided in June 2021. Next report to be provided by June 30, 2022 Develop and implement a Stakeholder Engagement Plan on Pharmaceutical Waste Disposal for district, provincial, Action Description and central hospitals and medical stores, identifying key players' roles from identification and preparation to monitoring. 10/25/2023 Page 7 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Source DLI# Responsibility Timing Timing Value Status Environmental and Social CMAM Due Date 31-Mar-2022 Revised Date Systems Completion Measurement Stakeholder Engagement Plan completed and monitored. Comments Pending completion. Establish, implement, and regularly monitor of an action plan to improve eSIP, including the integration of community Action Description health workers. Source DLI# Responsibility Timing Timing Value Status Technical DLI 7 MISAU - DHR Recurrent Semi-Annually In Progress Completion Measurement Semi-annual updates on the action plan for eSIP improvement. Comments Contracting of technical assistance is being finalized. Develop a plan to gradually incorporate contracted personnel to the civil service and regularly report reductions in Action Description contracted staff (fora do quadro) in primary health care facilities. Source DLI# Responsibility Timing Timing Value Status Technical DLI 7 MISAU - DHR Recurrent Semi-Annually In Progress Completion Measurement Semiannual reports on fora do quadro personnel in primary health care facilities. MISAU reported that by December 2020, 578 contractors paid by Program funds in primary facilities had been Comments incorporated into the civil service; 345 were incorporated by December 2021, and 155 have yet to be incorporated. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Substantial Substantial Substantial Other -- -- -- 10/25/2023 Page 8 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improve utilization of RMNCAH and Nutrition in underserved areas IN01304949 ►Number of districts, out of the 42 identified as lagging in the Investment Case, with at least 85 percent institutional deliveries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 28.00 32.00 34.00 37.00 Date 31-Dec-2019 31-Dec-2020 31-Dec-2022 30-Dec-2023 The percentage of institutional deliveries is defined as the total number of pregnant women who delivered their babies in a health facility in a priority district out of the total number of expected childbirths in the same district in a year. MISAU increased the number of districts to 32 in 2020, superseding the annual target of 29. Comments For 2021, MISAU reported that 31 districts reached the target. This data is pending validation currently being undertaken. For 2022, MISAU reported having reached 33 of the target set (37) districts. This result is pending validation and will be assessed during the current validation exercise. IN01304950 ►Number of Couple Years of Protection (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,722,692.00 3,110,723.00 4,336,444.00 3,450,000.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2022 30-Dec-2023 The 2020 target (3,190,000) was almost fully achieved.  For 2021 MISAU reported CYP of 3,246,552 (97% of the 2021 target). This data is pending validation.  Comments For 2022, MISAU reported CYP of 4,336,444 (largely surpassing the end target for the Program ), result pending validation. IN01304951 ►Percentage of children aged 0-24 months receiving a Nutrition Intervention Package in eight priority provinces (with the prevalence of stunting of above 35 percent) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 23.00 40.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2022 30-Dec-2023 For 2020, continued delays in the supply of critical inputs and the cessation of some activities during the pandemic resulted in coverage of 4% with the modified NIP (under the target of 15%). For 2021, MISAU reported achieving coverage of 16% (well under the target of 40%). This is pending validation. MISAU has hired an NGO to support execution for 2022. The end target will be revised through Comments restructuring.  For 2022, MISAU reported a coverage of 23%, i.e. slightly more than 50% of the target (target was 40%). This results is pending verification which is now ongoing. Improve the quality of RMNCAH-N in underserved areas 10/25/2023 Page 9 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) IN01304952 ►Number of lagging districts (as defined in the IC) that provide four doses of intermittent preventive treatment of malaria to at least 60 percent of pregnant women (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 11.00 11.00 30.00 Date 31-Dec-2020 31-Dec-2021 31-Dec-2022 31-Dec-2023 In 2021, MISAU reported 11 districts meeting the target. Comments In 2022, MISAU reported 11 districts. Intermediate Results Indicators by Results Areas Service delivery outputs IN01304957 ►Percentage of women who had at least four antenatal visits during their pregnancy (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 42.00 59.00 67.60 66.30 Date 29-Dec-2017 31-Dec-2020 31-Dec-2022 30-Dec-2023 In 2021, MISAU reported that 63 percent of pregnant women had at least four antenatal visits during their pregnancy. In 2020, MISAU reported that 59 percent of pregnant women had at least four antenatal visits during their Comments pregnancy (this figure is corrected from the last ISR). For 2022, MISAU reported a coverage of 67.6 percent (target for this year was 66.3 percent). This result will be verified in the current validation exercise. IN01304963 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 21,882,810.00 29,082,083.00 19,760,000.00 Date 29-Dec-2017 31-Dec-2021 31-Dec-2022 30-Dec-2023 Comments IN01304967 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,111,493.00 6,361,984.00 5,100,000.00 Date 29-Dec-2017 31-Dec-2021 31-Dec-2022 30-Dec-2023 IN01304968 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 13,178,179.00 20,377,452.00 9,720,000.00 10/25/2023 Page 10 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Date 29-Dec-2017 31-Dec-2021 31-Dec-2022 30-Dec-2023 IN01304970 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,593,138.00 5,903,136.00 4,940,000.00 Date 29-Dec-2017 31-Dec-2021 31-Dec-2022 30-Dec-2023 IN01304971 ►Number of provinces meeting annual Couple Years of Protection growth targets (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7.00 11.00 11.00 11.00 Date 31-Dec-2019 31-Dec-2021 31-Dec-2022 30-Dec-2023 Comments Service readiness and availability IN01304959 ►Number of health facilities providing Comprehensive Emergency Obstetric and Newborn Care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 33.00 33.00 61.00 60.00 Date 30-Dec-2014 30-Dec-2014 31-Dec-2022 30-Dec-2023 MISAU reported data from Provincial accreditation processes that was not verifiable. UNFPA is supporting accreditation processes but this work has been delayed and data is not yet available. The Program will Comments support monitoring of this indicator going forward. 2022 Target Achieved. MISAU reported that 61 health facilities provided COEmC in 2022. IN01304969 ►Percentage of secondary and technical schools offering sexual and reproductive health services (information and contraceptive methods) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 61.00 50.00 Date 31-Dec-2018 31-Dec-2018 31-Dec-2022 30-Dec-2023 In 2019, MISAU reported 233 (32%) of 710 secondary and technical schools received sexual and reproductive health (SRH) services. However, only 55.76% of a sample of 52 schools (22%) documented meeting all the criteria (including the provision of contraceptive methods, counseling, community engagement through school councils, and monitoring). In 2020, MISAU reported meeting the target of 19% of technical and secondary schools offering SRH Comments services. However, only 67.87% of the sample of 28 schools were found to meet the revised criteria.  In 2021, MISAU reported that 38% of secondary and technical offered SRH services. This is pending verification. For 2022, MISAU reported that 61% (433) of secondary and technical schools offered SRH services. The restructured target was 50%. To be verified during the current validation exercise. 10/25/2023 Page 11 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Human Resources for Health (HRH) IN01304956 ►Number of active community health workers (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3,380.00 6,690.00 7,929.00 8,800.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2022 30-Dec-2023 In 2021, MISAU reported that 7,301 APEs were active, pending verification. In 2022, the number of active APEs increased in 589, totaling 7,929, 84% of the end target. Comments IN01304958 ►Number of technical health personnel assigned to the primary health care network (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 11,970.00 15,923.00 23,029.00 17,153.00 Date 29-Dec-2017 30-Jun-2021 31-Dec-2022 30-Dec-2023 Cumulative number of technical health personnel assigned to the primary health care network Technical health personnel: career health professionals belonging to the health “special regime” or Regime Especial. This includes the following occupational areas: Nursing, Maternal Child Health Nurses, Curative Medicine, Preventive Medicine, Pharmacy, Laboratory, Surgery, Anesthesiology, Instrumentation, Nutrition, Radiology, Stomatology, Psychiatry and Mental Health, Physical Medicine of Rehabilitation, Ophthalmology, and Comments Otorhinolaryngology Primary health care network refers to the following health facilities: Rural Health Centers Type I and II and Urban Health Centers. By December 2022, MISAU reported an increase in the number of technical health personnel assigned to the primary health care network to 23,029(to be verified in the next validation exercise). IN01304966 Number of technical staff assigned to type II rural health centers (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 3,787.00 6,608.00 7,828.00 6,325.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2022 30-Dec-2023 IN01304965 ►Number of primary health care facilities that have at least two maternal child health nurses (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 638.00 698.00 869.00 768.00 Date 31-Dec-2018 30-Jun-2021 31-Dec-2022 30-Dec-2023 By December 2021, MISAU reported increasing the number of primary health care facilities that have at least two maternal child health nurses to 749 (pending verification). Comments For 2022, MISAU reported increasing the number of health care facilities that have at least two maternal child health nurses to 869 (to be verified in the next validation exercise). Quality IN01304955 ►Number of district and rural hospitals that received performance-based allocations in accordance with a minimum of one scorecard assessment in the previous fiscal year (Number, Custom) 10/25/2023 Page 12 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.00 43.00 44.00 Date 29-Dec-2017 31-Dec-2019 31-Dec-2022 30-Dec-2023 In 2018, six (6) district/rural hospitals received performance based allocations (PBA) based on the pilot scorecard assessment (14% of 44 total district/rural hospitals). In 2019, 15 district and rural hospitals (34%) received PBA based on two scorecard assessments. In 2020, 15 district and rural hospitals received PBA based on prioritized action plans  (the 2020 disbursement-linked result (DLR), following the suspension of scorecard evaluations due to COVID-19). Comments In 2021, MISAU reported t hat 34 district and rural hospitals (77%) received PBA based on at least one scorecard assessment (superseding the target of 31). This result is pending verification.  In 2022, MISAU reported that 43 (98%) out of 44 district and rural hospitals received PBA based on at least one scorecard assessment. IN01304960 ►Number of health centers in priority districts that received performance-based allocations in accordance with at least one scorecard assessment with community consultations in the previous FY (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 138.00 425.00 391.00 Date 29-Dec-2017 31-Dec-2019 31-Dec-2022 30-Dec-2023 In 2018, 64 Rural Health Centers received PBA based on scorecard evaluations, including community consultations. In 2019, a total of 186 health centers, 138 of which were Rural Health Centers, received PBA based on two scorecard evaluations.  However, the community consultations component did not take place due to the delay in contracting the non-governmental organization in charge of organizing them. In 2020,186 health centers received performance-based allocations based on prioritized action plans (the Comments 2020 DLR for which scorecard evaluations suspended due to COVID-19). In 2021, MISAU reported that 297 health centers received PBA based on at least one scorecard assessment, of which 222 also had community consultations conducted (leaving 39 community consultations to be conducted to reach the target of 261). This is pending verification.  In 2022, MISAU reported that 425 health centers received PBA based on at least one scorecard assessment. This is above the end target. Health Financing IN01304954 ►Domestic health expenditures as a percentage of total domestic government expenditures (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7.90 9.57 9.50 9.50 Date 29-Dec-2017 31-Dec-2020 31-Dec-2022 30-Dec-2022 In 2021, MISAU reported a result of 8.8% (below the target of 9.5%). This result in pending validation. In 2022, MISAU reported a result of 9.5%, which means that the 2021 target was also retrospectively Comments achieved. This result will be verified at the current validation exercise. This target was removed as part of the restructuring process. IN01304961 ►Health sub-account expenditures in 3 historically underserved provinces (Nampula, Zambezia, and Tete) (Amount(USD), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,010,000.00 3,010,000.00 9,000,000.00 10/25/2023 Page 13 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Date 29-Dec-2017 31-Dec-2020 31-Dec-2020 31-Dec-2021 Comments IN01304964 ►Health sub-account expenditures in 28 historically underserved districts (Amount(USD), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 620,000.00 620,000.00 4,000,000.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2020 31-Dec-2021 Comments Information for decision making IN01304953 ►Percentage of deaths in eligible health facilities certified by a doctor or qualified clinician with cause of death coded using ICD10, and the death record captured in the SISMA MGDH (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 51.70 57.20 70.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2022 30-Dec-2023 Measurement of this indicator began in 2020.  In 2021, MISAU reported a result of 62%, pending verification. Comments By the end of 2022, MISAU reported a result of 57.2% which will be verified in the ongoing verification exercise. IN01304962 ►Percentage of deaths registered, certified and captured in the civil registration system (SiRCEV) within one year of their occurrence (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8.54 11.00 25.00 Date 31-Dec-2017 31-Dec-2020 31-Dec-2022 30-Dec-2023 Measurement of this indicator began in 2020.  In 2021, MISAU reported a result of 9.4%, pending verification. Comments In 2022 MISAU reported a result of 11%, below the target of 25% for this year. Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 The Recipient has increased the number of districts, out of the 42 identified as lagging in the Investment Case, with at least 85 percent institutional deliveries (Intermediate Outcome, 10,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 28.00 32.00 33.00 -- Date -- 31-Dec-2020 31-Dec-2022 -- 10/25/2023 Page 14 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 2022: Target not achieved. MISAU reported that 33/37 of the 42 lagging districts increased or maintained Comments their level of institutional deliveries at or over 85% in 2021. IN01304973 DLI 1.1 The Recipient has increased the percentage of institutional deliveries in the 42 lagging districts defined in the Investment Case (Outcome, 10,700,000.00, 0%) Unit of Measure: Number Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 66.10 85.43 85.43 -- Date -- 31-Dec-2019 31-Dec-2019 -- This indicator is the previous DLI 1, which was discontinued and revised from 2020 on. 2018 Target Achieved. The percentage of institutional deliveries was 86. Comments 2019 Target Achieved. The percentage of institutional deliveries was 85. ►DLI 2 The Recipient has increased the percentage of secondary and technical schools offering sexual and reproductive health services (information and contraceptive methods) (Intermediate Outcome, 12,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 0.00 61.00 -- Date -- 31-Dec-2018 31-Dec-2022 -- 2022. Target was restructured to 50%. MISAU reported an achievement of 61%. This will be verified during the Comments current exercise. IN01304975 DLI 2.2 The Recipient has completed an identification of gaps in training materials (Process, 1,000,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No Yes Yes -- Date -- 31-Dec-2020 31-Dec-2020 -- No 2018 Target. No 2019 Target. Comments 2020 Target Achieved. IN01304976 10/25/2023 Page 15 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) DLI 2.3 The Recipient has finalized the harmonization of monitoring and evaluation tools (Process, 1,000,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No Yes Yes -- Date -- 31-Dec-2020 31-Dec-2020 -- No 2018 Target. No 2019 Target. Comments 2020 Target Achieved. IN01304977 DLI 2.4 The Recipient has approved updated training materials (Process, 1,000,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No No Yes -- Date -- 31-Dec-2020 31-Dec-2022 -- No Target for 2018-2020 2021 Target not achieved (materials were developed but revisions were requested internally for final Comments approval). 2022 Target achieved. The materials are approved. IN01304978 DLI 2.5 The Recipient has approved updated Adolescent- and Youth-friendly Services Guidelines (Process, 1,500,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No No Yes -- Date -- 31-Dec-2020 31-Dec-2022 -- Comments No Target for 2018-2020 10/25/2023 Page 16 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 2021 Target Not Achieved. MISAU reported that the guidelines for adolescents and youth-friendly services are developed but are pending approval. 2022 Target achieved. MISAU reported that the guidelines have been approved. IN01304979 DLI 2.7 The Recipient has trained health providers and focal points on improved monitoring and evaluation tools (Process, 1,000,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No No Yes -- Date -- 31-Dec-2020 31-Dec-2022 -- No Target for 2018-2021 2022 Target achieved. MISAU reported having trained health providers and focal points on improved Comments monitoring and evaluation tools ►DLI 3 The Recipient has increased Couple Years of Protection (Intermediate Outcome, 20,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 1,722,692.00 3,110,723.00 4,336,444.00 -- Date -- 31-Dec-2020 31-Dec-2022 -- 2018 Target Achieved. The number of CYP reported exceeded the target. 2019 Target Achieved. The number of CYP reported exceeded the target. 2020 Target Almost Fully Achieved. The result was 3,110,723 CYP for 2020, just below the target of 3,190,000.  Comments 2021 Target Almost Fully Achieved. MISAU reported CYP of 3,246,552 (97% of the target). 2022 Target Achieved and Surpassed. MISAU reported CYP of 4,336,444. ►DLI 4 The Recipient has increased the percentage of children between 0-24 months of age receiving the Nutrition Intervention Package in the eight provinces with a prevalence of stunting above 35 percent (Intermediate Outcome, 15,770,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 4.00 23.00 -- Date -- 31-Dec-2020 31-Dec-2022 -- 10/25/2023 Page 17 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 2022 Target. The restructured target of 40% was partially achieved (23%). Comments IN01304982 DLI 4.1 The Recipient has trained at least 6 trainers, 100% of district nutrition representatives, and 30% of Community Health Workers, and identified 30% of volunteers, in 6 of the 8 targeted provinces (Output, 2,500,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No Yes Yes -- Date -- 31-Dec-2018 31-Dec-2018 -- 2018 Target Achieved. The training of key personnel was completed. Comments IN01304983 DLI 4.2 The Recipient has finalized the Monitoring and Evaluation System (Process, 1,000,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No Yes Yes -- Date -- 31-Dec-2018 31-Dec-2018 -- 2018 Target Achieved. The Monitoring and Evaluation System has been developed. Comments ►DLI 5 The Recipient has increased the Domestic Health Expenditures as a percentage of total Domestic Government Expenditures. (Process, 13,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 7.90 9.57 9.57 -- Date -- 31-Dec-2020 31-Dec-2022 -- The baseline is the average of the three-year period 2014-2016. 2018 Target Achieved. MISAU reported that health sector expenditure exceeded the target of 8.5, reaching 8.87 of the actual domestic government expenditure. 2019 Target Achieved. MISAU reported that health sector expenditure exceeded the target of 8.5. Comments 2020 Target Achieved. MISAU reported that health sector expenditure exceeded the target of 9, reaching 9.57 of the actual government domestic expenditure.  2021 Target Not Achieved. MISAU reported a result of 8.8% (under the target of 9.5%). 2022 No Target. DLI restructured. The 2021 target was retrospectively achieved. ►DLI 6 The Recipient has increased health expenditures from the Sub-Account Resources in Underserved Provinces (Nampula, Zambezia, Tete) (Process, 1,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 10/25/2023 Page 18 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Value 0.00 3,010,000.00 3,010,000.00 -- Date -- 31-Dec-2020 31-Dec-2022 -- In the 2022 restructuring process, this indicator refers to disbursements to 90% of primary health care units with hospitalization in the three needy provinces (Nampula, Zambézia and Tete). This target has been Comments surpassed as disbursements were made to 100% of the health care units with hospitalization. IN01304986 DLI 6.1 The Recipient has increased health expenditures from the Sub-Account Resources in the 28 Underserved Districts in the three Underserved Provinces (Process, 1,000,000.00, 0%) Unit of Measure: Amount(USD) Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 620,000.00 620,000.00 -- Date -- 31-Dec-2020 31-Dec-2020 -- Comments IN01304987 DLI 6.2 The Recipient has maintained Domestic Health Expenditures for the three Underserved Provinces (Nampula, Zambezia, Tete) as a share of provincial Domestic Health Expenditures (Process, 500,000.00, 0%) Unit of Measure: Amount(USD) Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 32.00 35.60 35.60 -- Date -- 31-Dec-2020 31-Dec-2020 -- Comments IN01304988 DLI 6.3 The Recipient has maintained Domestic Health Expenditures for the 28 Underserved Districts in the three Underserved Provinces as a share of district Domestic Health Expenditures (Process, 500,000.00, 0%) Unit of Measure: Amount(USD) Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 16.00 15.40 15.40 -- Date -- 31-Dec-2020 31-Dec-2020 -- Comments IN01304989 DLI 6.4 The Recipient has increased the number of provinces with Program Contracts (Process, 1,000,000.00, 0%) Unit of Measure: Number Indicator Type: 10/25/2023 Page 19 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 0.00 0.00 -- Date -- 31-Dec-2019 31-Dec-2019 -- Comments IN01304990 DLI 6.5 The Recipient has disbursed grants to 90% of primary health care facilities with internment in the three Underserved Provinces (Output, 3,000,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 0.00 0.00 -- Date -- 13-Jul-2022 13-Jul-2022 -- Comments ►DLI 7 The Recipient has increased the number of technical health personnel assigned to the primary health care network (Process, 11,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 11,970.00 15,923.00 23,029.00 -- Date -- 30-Jun-2021 31-Dec-2022 -- 2022 Target Achieved: MISAU reported that 23,029 technical health personnel were mapped to primary care Comments facilities superseding the target of 17,153. IN01304992 DLI 7.1 The Recipient has increased the number of health care facilities in the primary care network that have at least two active Maternal Child Health Nurses (Process, 5,000,000.00, 0%) Unit of Measure: Number Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 638.00 698.00 868.00 -- Date -- 31-Dec-2020 31-Dec-2022 -- 2022 Target Achieved: MISAU reported that 23,029 technical health personnel were mapped to primary care facilities superseding the target of 17,153. 868 facilities were listed as having two or more MCH, above the Comments target of 768. ►DLI 8 The Recipient has increased the number of district and rural hospitals receiving performance-based allocations in accordance with a minimum of one scorecard assessment in the previous fiscal year (Process, 17,000,000.00, 0%) 10/25/2023 Page 20 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 15.00 43.00 -- Date -- 31-Dec-2019 31-Dec-2022 -- 2018 Target Achieved. MISAU reported that six (6) hospitals received PBA based on the pilot scorecard. 2019 Target Achieved. MISAU reported that 15 district and rural hospitals (36% of 42 total) received PBA based on two score-card assessments. No 2020 Target. Comments 2021 Target Achieved. MISAU reported that 34 district and rural hospitals (77%) received PBA based on at least one scorecard assessment (superseding the target of 31). This result is pending verification. 2022 Target Partially Achieved. MISAU reported that 43 district and rural hospitals received PBA based on at least one scorecard assessment IN01304994 DLI 8.1 The Recipient has increased the number of district and rural hospitals that receive allocations based on prioritized action plans that respond to scorecard evaluations (Process, 5,500,000.00, 0%) Unit of Measure: Number Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 15.00 15.00 -- Date -- 31-Dec-2020 31-Dec-2020 -- No 2018 Target. No 2019 Target. 2020 Target Achieved. 15 (30 percent) district and rural hospitals received allocations based on prioritized action plans responding to scorecard evaluations was achieved.  Comments No 2021 Target. ►DLI 9 The Recipient has increased the number of health centers in priority districts receiving PBA according to at least one scorecard assessment with community consultations in the previous fiscal year (Process, 20,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 138.00 425.00 -- Date -- 31-Dec-2019 31-Dec-2022 -- 2022 Target Achieved. MISAU reported 425 health centres in priority districts receive PBA in accordance with Comments a minimum of one scorecard assessment (superseding that portion of the target). IN01304996 DLI 9.1 The Recipient has increased the number of health centers in priority districts that received allocations to implement prioritized action plans responding to scorecards evaluations (Process, 6,000,000.00, 0%) Unit of Measure: Number Indicator Type: 10/25/2023 Page 21 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 186.00 186.00 -- Date -- 31-Dec-2020 31-Dec-2020 -- No 2018 Target. No 2019 Target. 2020 Target Achieved. 186 health centers received allocations based on prioritized action plans responding to scorecard evaluations, achieving the target. Comments No 2021 Target. ►DLI 10 The Recipient has increased the number of active Community Health Workers (Process, 15,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 3,380.00 6,690.00 7,229.00 -- Date -- 31-Dec-2020 31-Dec-2022 -- 2018 Target Achieved. 5,033 APEs were trained and active by the end of 2018, surpassing the target of 4,723. 2019 Target Retroactively Achieved. 5,094 APEs were trained and active by the end of 2019, representing partial achievement in relation to the annual  target of 6,523 of 2019. Comments 2020 Target Achieved.  6,690 APEs were active by the end of 2020.  2021 Target Achieved. In 2021, MISAU reported that 7,301 APEs were active, pending verification. 2022 Target Not Achieved. In 2022 the number of active APEs reported by MISAU was 7,929. The programatic target was not achieved. IN01304998 DLI 10.1 The Recipient has increased the percentage of Community Health Workers that deliver services according to quality standards (Intermediate Outcome, 3,500,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 28.00 28.00 28.00 -- Date -- 31-Jan-2020 31-Jan-2020 -- Comments No 2018 Target. No 2019 Target. No 2020 Target. 2021 Target Pending Verification. The baseline study concluded in December 2020 on the quality of services provided by the APE which showed a very low percentage of APEs meeting quality standards (28%, based on a composite calculation of having basic medicines/contraceptives and diagnostic capacity). In the Program restructuring, the quality target will be reduced to 50% and shifted to 2022 to enable implementation of reforms to address identified gaps. 10/25/2023 Page 22 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 2022 Target was not achieved. MISAU reported not having conducted the quality study on the performance of the APSs. ►DLI 11 The Recipient has increased the percentage of deaths in eligible health facilities certified by a qualified clinician with cause of death coded using ICD10/11, and the death record captured in SISMA (Process, 7,400,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 51.70 57.20 -- Date -- 31-Dec-2020 31-Dec-2022 -- Measurement of this indicator began in 2020.  In 2021, MISAU reported a result of 62%, pending verification. Comments By the end of 2022, MISAU reported a result of 57.2% (target was 90%) which is currently under verification. IN01305000 DLI 11.1 The Recipient has increased the percentage of hospitals using the Hospital Data Management Module (MGDH) to generate information on causes of deaths (Process, 1,500,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 70.00 100.00 100.00 -- Date -- 31-Dec-2018 31-Dec-2018 -- 2018 Target Achieved. Comments No Target for 2019-2021. IN01305001 DLI 11.2 The Recipient has increased the percentage of health centers using the Hospital Data Management Module (MGDH) to generate information on causes of deaths (Process, 6,000,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 77.60 77.60 -- Date -- 31-Dec-2019 31-Dec-2019 -- Comments IN01305002 DLI 11.3 The Recipient has increased the percentage of deaths registered, certified and captured in the civil registration system (SiRCEV) within one year of their occurrence (Intermediate Outcome, 1,900,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 10/25/2023 Page 23 of 24 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Value 0.00 8.54 11.00 -- Date -- 31-Dec-2020 31-Dec-2022 -- 11% of deaths were registered, certified and captured in the civil registration system (SiRCEV) within one year of their occurrence this is pending validation. Comments ►DLI 12 The Recipient has introduced reforms to increase the availability of essential maternal and reproductive health medicines at primary health care facilities (Intermediate Outcome, 3,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Reforms introduced - Value Reforms not introduced Reforms not introduced -- Comando Unico Date -- 31-Dec-2020 31-Dec-2022 -- Approval by the Cabinet of a decree granting the Central de Medicamentos e Artigos Médicos (CMAM) Comments autonomy to enable an optimized single command structure. IN01305004 DLI 12.1 Implementation of outsourcing of last mile transportation and distribution of medicines (Intermediate Outcome, 1,500,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No No Yes -- Date -- 31-Dec-2020 31-Dec-2022 -- MISAU is implementing outsourcing of last mile transportation and distribution of medicines through Boloré. Comments 10/25/2023 Page 24 of 24