The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) Health Sector Development Support Project (P125229) EASTERN AND SOUTHERN AFRICA | Zimbabwe | Health, Nutrition & Population Global Practice | Recipient Executed Activities | Investment Project Financing | FY 2012 | Seq No: 21 | ARCHIVED on 28-Nov-2022 | ISR53472 | Implementing Agencies: Republic of Zimbabwe, Stichting Cordaid Key Dates Key Project Dates Bank Approval Date: 29-Sep-2011 Effectiveness Date: 08-Dec-2011 Planned Mid Term Review Date: 11-Feb-2013 Actual Mid-Term Review Date: 22-Feb-2013 Original Closing Date: 30-Apr-2023 Revised Closing Date: 30-Apr-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to increase coverage of key maternal and child health interventions in targeted ruraldistricts consistent with the Recipient's ongoing health initiatives. 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 increase coverage and quality of an integrated package of Reproductive, Maternal, Neonatal, Child, Adolescent health and nutrition (RMNCAH-N) services, as well as strengthen COVID-19 response and institutional capacity to manage performance-based contracts consistent with the Recipients’ ongoing health initiatives. Components Table Name Results Based Financing in Delivery of Packages of Key Maternal, Child, and Other Related Health Services (RMNCAH-N):(Cost $36.85 M) Management and Capacity Building:(Cost $26.30 M) Monitoring, Documentation, and Verification of Results under Performance-based Contracts:(Cost $4.55 M) COVID-19 Response:(Cost $5.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions 11/28/2022 Page 1 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) The total grant financing for the Health Sector Development Support (HSDS) Project is US$78 million, made up of the original US$15 million grant approved in September 2011 and US$63 million through five additional grants approved between 2013 and 2020. The most recent, fifth additional financing (AF V), approved in September 2020, became effective in December 2020. The HSDS Project has made significant progress since 2011. AF V aims to improve the coverage and quality of reproductive, maternal, neonatal, child health and nutrition indicators and strengthen the Government of Zimbabwe's COVID-19 response. To date, despite implementation challenges posed mainly by the COVID-19 pandemic and Zimbabwe's fiscal situation, the project has achieved two of its five project development indicators, namely, over 80 percent of close contacts of confirmed COVID-19 cases have been followed up based on national guidelines and 57% of hospitals increased their quality scores. Additionally, four out of the 22 intermediate results indicators have already met or surpassed their targets: 936,7131 children completing their primary course on immunization in participating districts; average availability of PPE commodities is 91% in health facilities; 20 District Health Executives in participating districts using the updated quality checklist with the COVID-19 component for supervision of health facilities; and 15 COVID treatment centers with oxygen therapy. Progress has also been made for 8 intermediate results indicators which increased since December 2021. While there have been notable achievements, several activities remain delayed. The Government and CORDAID (Project Implementation Entity) are taking steps to accelerate implementation. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Substantial Substantial Sector Strategies and Policies -- Low Low Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and -- Substantial Substantial Sustainability Fiduciary -- Substantial Substantial Environment and Social -- Substantial Substantial Stakeholders -- Moderate Moderate Other -- Low Low Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes Increase coverage of key RMNCAH-N services in participating districts IN01203922 ►Percentage of women who had their first ANC visit during the first twelve weeks of pregnancy in participating rural districts (Percentage, Custom) 11/28/2022 Page 2 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 22.00 22.00 32.00 Date 31-Dec-2012 31-Dec-2021 30-Jun-2022 30-Apr-2023 IN01203924 ►Percentage of children 6 to 59 months with vitamin A supplementation in participating rural districts. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 40.00 28.00 31.00 50.00 Date 31-Dec-2019 31-Dec-2021 30-Jun-2022 30-Apr-2023 MOHCC and PIE confirmed that baseline should have been 30 percent instead of 40 percent. This indicator's baseline and target will be adjusted through a project restructuring. Comments: Increase quality of key MCH services in participating districts IN01203923 ►Percentage of participating district, provincial and central hospitals that have registered an increase in quality scores since last quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 25.00 41.00 57.00 50.00 Date 31-Dec-2019 31-Dec-2021 30-Jun-2022 30-Apr-2023 Closing target met. While performance decreased in December 2021 due to the COVID-19 pandemic, it Comments: improved by June 2022. Strengthen institutional capacity in RBF Contract Management IN01203920 ►Percentage of health facilities managed under RBF contracts by the MOHCC Program Coordination Unit in participating rural districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 23.90 28.00 80.00 Date 31-Dec-2012 31-Dec-2021 30-Aug-2022 30-Apr-2023 Strengthen COVID-19 response IN01203921 ►Percentage of close contacts of confirmed COVID-19 cases followed up based on national guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 81.00 82.00 80.00 Date 28-Feb-2020 31-Dec-2021 30-Jun-2022 30-Jun-2021 11/28/2022 Page 3 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) End target surpassed. Comments: Intermediate Results Indicators by Components Component 1: Delivery of Packages of RMNCAH-N and Other Related Health Services IN01203926 ►Cumulative number of health facilities enrolled in RBF program in participating districts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 451.00 452.00 1,155.00 Date 31-Dec-2012 31-Dec-2021 30-Jun-2022 30-Apr-2023 . Comments: IN01203937 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,410,518.00 4,752,425.00 4,847,512.00 Date 31-Dec-2012 31-Dec-2021 30-Jun-2022 30-Apr-2023 IN01203940 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 2,289,059.00 2,466,507.00 2,515,859.00 IN01203941 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 872,595.00 936,731.00 929,004.00 Date 31-Dec-2012 31-Dec-2021 30-Jun-2022 30-Apr-2023 IN01203942 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,462,636.00 2,676,389.00 2,768,670.00 Date 31-Dec-2012 31-Dec-2021 30-Jun-2022 30-Apr-2023 IN01203943 11/28/2022 Page 4 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,075,287.00 1,139,303.00 1,149,839.00 Date 31-Dec-2012 31-Dec-2021 30-Jun-2022 30-Apr-2023 IN01203944 ►Cumulative number of children under 5 who had their Mid Upper Arm Circumference and Height measured by Community Health Workers (CHWs) as part of growth monitoring. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 121,500.00 Date 27-Apr-2020 31-Dec-2021 30-Jun-2022 30-Apr-2023 No change. Community-based RBF not yet initiated for this indicator to be measured. Comments: IN01203945 ►Percentage of 15-49-year-old women who are new acceptors of long term, reversible family planning methods in participating districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 21.40 18.00 17.00 30.00 Date 31-Dec-2019 31-Dec-2021 30-Jun-2022 30-Apr-2023 Decreased since last ISR due mainly to staffing shortages in addition to challenges associated with Comments: service utilization during the COVID-19 pandemic and macroeconomic situation (inflation). Component 2. Management and Capacity Building in RBF IN01203925 ►Number of health personnel and community health workers (CHWs) receiving training on RBF in participating districts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,222.00 5,424.00 5,792.00 Date 31-Dec-2012 31-Dec-2021 30-Jun-2022 30-Apr-2023 IN01203927 ►Percentage of health facilities implementing Continuous Quality Improvement (CQI) model in the participating rural districts. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 17.00 23.00 70.00 Date 01-Sep-2015 31-Dec-2021 30-Jun-2022 30-Apr-2023 IN01203931 ►Number of health workers that received first time training or refresher training on Emergency Obstetrics and Neonatal Care using skill labs (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/28/2022 Page 5 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) Value 0.00 0.00 0.00 280.00 Date 27-Apr-2020 31-Dec-2021 30-Jun-2022 30-Apr-2023 No change since last ISR. The trainings will be given as part of the quality focused RBF pilot for central Comments: and provincial pilot which have been delayed due to COVID-19. IN01203934 ►Percentage of MOHCC cost centers utilizing resource allocation formula in line with the whole Government Management Performance System (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 01-Jan-2020 31-Dec-2021 30-Jun-2022 30-Apr-2023 No change. Delays due to MOHCC's decision to coordinate this task with WHO. A consultant to support Comments: the MOHCC to develop the resource allocation criteria is expected to be in place in late 2022/early 2023. IN01203936 ►Percentage of resources allocated to primary health care (PHC) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 5.00 5.00 8.00 Date 31-Jan-2020 31-Dec-2021 30-Jun-2022 30-Apr-2023 No change. This allocation is based on the GOZ budget blue book. This indicator will be deleted as part of Comments: planned restructuring because it is beyond the control of the project. Component 3.Monitoring, Documentation, Verification of Results under Performance-based Financing IN01203930 ►Number of District Health Executives (DHEs) in participating districts using updated quality checklist with the COVID-19 component for supervision of health facilities. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 20.00 25.00 20.00 Date 27-Apr-2020 31-Dec-2021 30-Jun-2022 30-Apr-2023 Target has been surpassed and will be revised as part of planned RF restructuring. Comments: IN01203933 ►Process evaluation to examine the institutionalization of RBF in the government system as a viable approach to sustainability of RBF (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 27-Apr-2020 31-Dec-2021 30-Jun-2022 30-Apr-2023 Process evaluation has been delayed by COVID-related restrictions and MOHCC's competing priorities. Comments: IN01203935 11/28/2022 Page 6 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) ►Process evaluation to examine the effectiveness of quality focused RBF at provincial hospitals in improving the quality of maternal and neonatal care for improved outcomes. (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 27-Apr-2020 31-Dec-2021 30-Jun-2022 29-Jul-2022 Not yet due. Process for evaluation will start after the quality focused RBF pilot has been implemented for Comments: at least a year. IN01203939 ►Percentage of grievances addressed within 4 weeks of initial complaint being recorded (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 47.60 65.00 Date 31-Jan-2020 31-Dec-2021 30-Jun-2022 30-Apr-2023 Progress made since last ISR. It was agreed that this indicator will measure the Number of project related Comments: grievances addressed within the required terms /total number of project related grievances received. COVID-19 Response IN01203928 ►Percentage of health facilities with minimum package of PPE (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 89.00 91.00 70.00 Date 31-Jan-2020 31-Dec-2021 30-Jun-2022 31-Dec-2020 The recent Vital Medicines Availability and Health Services Survey for Q2 2022 used by the COVID-19 Response logistics pillar indicates that the average availability for a package of PPE (caps, masks, gloves, gowns, goggles) is 91%. The proxy indicator's achievement exceeds the project closing target. Comments: This indicator will be revised as part of the RF restructuring based on the definition used by existing data sources. IN01203929 ►Percentage of affected people including health workers reached with clinical and psycho-social support (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 28-Feb-2020 31-Dec-2021 30-Jun-2022 31-Dec-2020 Data will be reported once project-related support starts in late 2022. Support has been delayed because the Call Center Annex which is expected to provide psychosocial support experienced delays in setting up Comments: a hotline. The last ISR erroneously reported 10 percent instead of 0. IN01203932 ►Number of isolation centers complying with infection prevention control (IPC) guidelines (Number, Custom) 11/28/2022 Page 7 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 5.00 Date 31-Jan-2020 31-Dec-2021 30-Jun-2022 31-Dec-2020 Prospective contractors visited the sites of the 5 isolation centers for pre-bid assessment. Renovations will start once the successful contractors are identified. Tracking will commence once the water tanks have been installed in these centers. Comments: Given the composite nature of the indicator, it will be difficult to measure it without an agreed index/criteria and regular data sources. It will be revised as part of the planned RF restructuring. IN01203938 ►Number of COVID treatment centers with oxygen therapy (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.00 15.00 5.00 Date 31-Jan-2020 31-Dec-2021 30-Jun-2022 31-Dec-2020 Target exceeded. Given that efforts are underway to have additional hospitals with functional oxygen therapy with support from GOZ and partners, the target will be adjusted as part of planned RF Comments: restructuring. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P125229 TF-10748 Closed USD 15.00 15.00 0.00 15.00 0.00 100% P125229 TF-15111 Closed USD 20.00 20.00 0.00 20.00 0.00 100% P125229 TF-A1598 Closed USD 10.00 10.00 0.00 10.00 0.00 100% P125229 TF-A5311 Closed USD 5.00 5.00 0.00 5.00 0.00 100% P125229 TF-A9037 Closed USD 3.00 3.00 0.00 3.00 0.00 100% P125229 TF-B3156 Effective USD 25.00 25.00 0.00 12.91 12.09 52% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P125229 TF-10748 Closed 27-Sep-2011 27-Sep-2011 08-Dec-2011 31-Jul-2014 31-Jul-2014 P125229 TF-15111 Closed 30-Jul-2013 30-Jul-2013 25-Sep-2013 30-Oct-2015 28-Feb-2017 11/28/2022 Page 8 of 9 The World Bank Implementation Status & Results Report Health Sector Development Support Project (P125229) P125229 TF-A1598 Closed 23-Dec-2015 12-Jan-2016 14-Mar-2016 28-Feb-2017 30-Jan-2018 P125229 TF-A5311 Closed 21-Jul-2017 26-Jul-2017 24-Oct-2017 30-Jun-2018 31-Dec-2019 P125229 TF-A9037 Closed 03-Nov-2018 20-Feb-2019 29-Mar-2019 31-Dec-2019 31-Dec-2020 P125229 TF-B3156 Effective 20-Sep-2020 01-Oct-2020 04-Dec-2020 30-Apr-2023 30-Apr-2023 Cumulative Disbursements Restructuring History Level 2 Approved on 01-Sep-2015 ,Level 2 Approved on 21-Feb-2017 ,Level 2 Approved on 27-Jun-2018 ,Level 2 Approved on 20-Dec-2018 ,Level 2 Approved on 06-Dec-2019 ,Level 2 Approved on 25-Jun-2020 Related Project(s) P144532-Additional Financing Health Sector Development Support Project ,P156879-Zimbabwe Health Sector Development Support Project AF II ,P163976-Zimbabwe Health Sector Development Support Project III - AF ,P168734-Zimbabwe Health Sector Development Support Project IV - AF ,P173132-Health Sector Development Support Project - Additional Financing V ,P175232-Health Sector Development Support 11/28/2022 Page 9 of 9