The World Bank Implementation Status & Results Report Sierra Leone - Quality Essential Health Services and Systems Support Project (P172102) Sierra Leone - Quality Essential Health Services and Systems Support Project (P172102) WESTERN AND CENTRAL AFRICA | Sierra Leone | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2022 | Seq No: 4 | ARCHIVED on 20-Dec-2023 | ISR58034 | Implementing Agencies: Integrated Health Project Administration Unit (IHPAU), Partners in Health (PIH), Republic of Sierra Leone Key Dates Key Project Dates Bank Approval Date: 09-Dec-2021 Effectiveness Date: 15-Mar-2022 Planned Mid Term Review Date: 30-Apr-2024 Actual Mid-Term Review Date: Original Closing Date: 31-Dec-2027 Revised Closing Date: 31-Dec-2027 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The PDO is to increase utilization and improve quality of maternal and child health services in the selected areas. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Improving Quality, Efficiency, and Effectiveness of Reproductive, Maternal, Newborn, Child Health and Nutrition Services:(Cost $31.28 M) Component 2: Strengthening National Level Systems:(Cost $15.40 M) Component 3: Project Management and Monitoring and Evaluation:(Cost $10.02 M) Component 4: Contingent Emergency Response project (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions Significant progress has been made in the second year of project implementation. Under Component 1 (Improving Quality, Efficiency, and Effectiveness o to provide technical support has been done, and the recruitment of clinical staff for the delivery of clinical services in the 14 hubs is ongoing. Essential drug and plans are underway for the project districts and last mile distribution. In Kailahun, clinical services are already being provided in the newly built health capacity to provide effective referral services. Progress in the implementation of Component 2 (Strengthening National-Level Systems) has also progresse of training curricula for critical health training including Health Economics, review and update of WASH standard operation procedures, protocols, and guid capacity building for teachers and clinical staff in handling Gender Based Violence cases. A consultant has also been recruited to support the strengthenin Facility continue to provide TA and advisory services to strengthen the IHPAU. 12/20/2023 Page 1 of 9 The World Bank Implementation Status & Results Report Sierra Leone - Quality Essential Health Services and Systems Support Project (P172102) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Substantial Substantial Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and High High High Sustainability Fiduciary Substantial Substantial Substantial Environment and Social High Substantial Substantial Stakeholders Moderate Moderate Moderate Other Substantial Moderate Moderate Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes People who have received essential HNP services (Number) IN01347298 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 1,676,654.00 643,024.00 14,321,430,918.00 2,084,555.00 Date 30-Sep-2021 31-Dec-2022 30-Sep-2023 31-Dec-2026 This indicator is not on track to be met for 2023. This is due to a calculation error during project preparation that largely overestimated the target population for vaccination and which directly affects Comments: PDO1a and PDO1b and consequently the overall PDO1 IN01347332 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 1,110,493.00 244,821.00 762,272.00 1,359,000.00 12/20/2023 Page 2 of 9 The World Bank Implementation Status & Results Report Sierra Leone - Quality Essential Health Services and Systems Support Project (P172102) IN01347333 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1,060,233.00 59,930.00 130,148.00 1,272,280.00 Date 19-May-2021 31-Dec-2022 30-Sep-2023 31-Dec-2026 IN01347334 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 563,384.00 538,222.00 1,207,145.00 731,074.00 Date 19-May-2021 31-Dec-2022 30-Sep-2023 31-Dec-2026 IN01347335 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 53,037.00 44,872.00 93,625.00 81,201.00 Date 19-May-2021 31-Dec-2022 30-Sep-2023 31-Dec-2026 Pregnant women attended ANC4+ times by skilled health personnel in target districts (Percentage) IN01347299 ►Pregnant women attended ANC4+ times by skilled health personnel in target districts (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 64.00 79.00 90.00 77.00 Date 25-Oct-2021 31-Dec-2022 30-Sep-2023 31-Dec-2026 This indicator is on track to be met for 2023. However, data reported (as per the definition of the indicator) is accounting for women that attend ANC4 and ANC 8 which leads to instances of double counting. The definition of this indicator will have to be clarified during the MTR. Comments: Numerator: Number of women (ages 15-49 years) who were attended ANC 4+ times by any health personnel during pregnancy in target districts Denominator: Number of pregnancies expected among women (ages 15-49 years) in target districts. Institutional Delivery Rate (Percentage) IN01347331 ►Institutional delivery rate in the target districts (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 57.00 60.00 69.00 80.00 Date 25-Oct-2021 31-Dec-2022 30-Sep-2023 31-Dec-2026 This indicator is on track to be met for 2023. Institutional delivery rates reported under the project account Comments: only for deliveries assisted by qualified personnel to account for quality of services. 12/20/2023 Page 3 of 9 The World Bank Implementation Status & Results Report Sierra Leone - Quality Essential Health Services and Systems Support Project (P172102) Numerator: Number of deliveries in all health facilities in target districts Denominator: Number of deliveries expected among women (ages 15-49 years) in target districts Quality of care IN01347300 ►Average Score of Health Facility Quality of Care in the target facilities (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 44.00 0.00 51.00 64.00 Date 25-Oct-2021 30-Dec-2022 30-Sep-2023 31-Dec-2026 The target for 2023 is on track to be met. The data reported for as of September 2023 represents the baseline collected in August 2023. The target for this indicator will have to be increased during the MTR. Comments: Intermediate Results Indicators by Components Improving quality, efficiency, and effectiveness of Reproductive, Maternal, Newborn,Child and Health IN01347336 ►Children 0-59 months admitted for SAM, that are cured of SAM in target facilities (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.00 35.00 30.00 70.00 Date 09-Apr-2021 31-Dec-2022 30-Sep-2023 31-Dec-2026 This indicator is not on track to be met for 2023. The result provided is for the total of health facilities in the 5 districts rather than the target health facilities. This is due to the fact that SAM treatment is only provided at hospital level whereas the project targets lower level primary health care facilities. This indicator needs Comments: to be revised to capture MAM treatment in the 14 target health facilities during the upcoming restructuring. Numerator: Number of children admitted for severe acute malnutrition at selected health facility who are cured. Denominator: Number of children admitted for severe acute malnutrition at selected health facility IN01347337 ►Pregnant Women and Children under 5 years old who receive a CHW visit in target district (Number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 56,360.00 84,116.00 106,310.00 70,450.00 Date 09-Apr-2021 31-Dec-2022 30-Sep-2023 31-Dec-2026 Target for 2023 is on track to be met. The performance has varied considerably quarter by quarter due to reforms within the CHW program and changes in the data reporting system (from paper based to digital) Comments: was met. Total, annual number pregnant women, lactating mothers and children under five years of age visited by a CHW, in target districts. IN01347339 ►Deliveries referred from spokes to hubs in target districts (Number) (Number, Custom) 12/20/2023 Page 4 of 9 The World Bank Implementation Status & Results Report Sierra Leone - Quality Essential Health Services and Systems Support Project (P172102) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 435.00 5,000.00 Date 09-Apr-2021 31-Dec-2022 30-Sep-2023 31-Dec-2026 This activity is not on track to be met for 2023. The number of referrals is lower than expected due to delays in the readiness of health facilities and challenges with the referral mechanisms agreed with Comments: NEMS. It is expected that this indicator will show considerable progress before the end of 2023. Definition: Cumulative number of deliveries referred from Spoke facilities to HUB CHCs. IN01347341 ►Children 0-11 months that received third dose of Penta vaccine in target districts (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 84.00 88.00 88.00 95.00 Date 09-Apr-2021 31-Dec-2022 31-Dec-2022 31-Dec-2026 Data for 2023 is not yet available as needs to be discussed and validated with the Expanded Immunization Program. Results will be provided by end 2023, considering the full denominator of estimated surviving infants for 2023. Comments: Numerator: Number children (ages 0 -11 months) receiving all of the basic vaccinations in target districts, annually Denominator: Estimated number of surviving infants [aged less than 1 year] in target districts, annually IN01347343 ►Couple-Year Protections (CYP) reached through project interventions in target districts (Number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45,922.00 45,922.00 166,165.00 68,883.00 Date 09-Apr-2021 14-Nov-2022 30-Dec-2022 31-Dec-2026 This indicator is reported on an annual basis and so the latest data available is for up to December 2022. This indicator is considered to be on track given that it was largely met in 2022. Discussions during the MTR next year will consider how to revise this indicator upwards Comments: CYP is calculated summing the product of the quantity of each FP commodity distributed/provided to client by a conversion factor for each method during a given period. IN01347347 ►Maternal deaths reviewed in target districts (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 80.00 81.00 100.00 Date 09-Apr-2021 14-Nov-2022 30-Sep-2023 31-Dec-2026 This indicator is on track to be met for 2023. Support to the districts and the in-charge meetings have allowed for this indicator to progress during Q4 and catch up with the backlog from previous quarters. Comments: Numerator: Total number of Maternal Deaths Audited (reviewed) in health districts Denominator: Total number of maternal deaths reported in target districts. IN01347349 ►Health facilities in target district with staff trained to identify, refer, and provide clinical and/or psychosocial care for GBV (Number) (Percentage, Custom) 12/20/2023 Page 5 of 9 The World Bank Implementation Status & Results Report Sierra Leone - Quality Essential Health Services and Systems Support Project (P172102) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 250.00 Date 09-Apr-2021 31-Dec-2022 30-Sep-2023 31-Dec-2026 This activity is not on track to be met for 2023. A consultant has now been hired and it is expected that the target will be partially met before the end of the year. Comments: Cumulative health care facilities with staff that passed the post-assessment exam following the training course on GBV. Component 2: Strengthening National Level Systems IN01347338 ►Health facilities submitting timely routine/HMIS reports according to national guidelines (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 82.00 82.00 57.00 98.00 Date 09-Apr-2021 14-Nov-2022 30-Sep-2023 31-Dec-2026 This indicator is not on track to be met for 2023. New Standard Operating Procedures for electronic data entry are being rolled out in Sierra Leone and these are often hindered by network availability. Improving timely reporting is being discussed as part of general TA to M&E that is planned for Q4 2023 and Q1 Comments: 2024. Numerator: Number of health facilities (PHUs, DH, etc.) submitting timely monthly reports (to the districts). Denominator: Total number of health facilities expected to report in the time period IN01347340 ►Healthcare Waste treated at the Centralized Medical Waste Treatment Facility (Metric tons/year) (Metric tons/year, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 547.50 Date 25-Oct-2021 31-Dec-2022 30-Sep-2023 31-Dec-2026 This indictor is on track to to be met in 2023 as it was not planned for this activity to begin. Numerator Total Number of Infectious Waste generated per facility per Kg per patient per day + Number Comments: of Sharps Waste Generated per facility per Kg per patient per day. Denominator: Total number of waste collection days IN01347342 ►Monthly facility management committee (FMC) meetings held in target districts (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 25-Oct-2021 30-Dec-2022 30-Sep-2023 31-Dec-2026 This indicator is not on track to be met for 2023. Facility Management Committees are being reactivated and meetings will be supported before the end of the year at the target health facilities. However, this indicator will have to be revised during the MTR to reflect only the hubs or the hubs and the spokes, but Comments: the project cannot be responsible for FMC meetings across health facilities across all districts as that also has financial implications Numerator: Number of monthly FMC meeting held by FMC in targeted districts, each year Denominator: Total number of expected monthly FMC meeting to be held in targeted districts 12/20/2023 Page 6 of 9 The World Bank Implementation Status & Results Report Sierra Leone - Quality Essential Health Services and Systems Support Project (P172102) IN01347344 ►Essential Health service delivery monitored on a regular basis, with quarterly review of data to inform efforts to strengthen delivery (Number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 25-Oct-2021 30-Dec-2022 30-Sep-2023 31-Dec-2026 This indicator is not on track to being met. A meeting facilitated by the GFF at the end of October 2023 reviewed data for the first time (this result will be included in the next ISR as it is Q4 data). GFF is working with the RMNCHAN department to support the establishment of a new TWG that review these Comments: indicators and activities on a quarterly basis. Definition: Number of times that routine (monthly) Monitoring of Essential Health Services (mEHS) reports are reviewed by the Country Platform IN01347345 ►Grievances addressed each year (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 95.00 Date 25-Oct-2021 30-Dec-2022 30-Sep-2023 31-Dec-2026 This indicator is not on track to be met. At the time of reporting, the GRM mechanism has been approved by the Bank and will begin to be operationalized before the end of 2023 Comments: Numerator: Number of grievances reported and addressed Denominator: Total number f grievances reported IN01347346 ►RMET completed and used annually, including data from the district level (Yes/No) (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 25-Oct-2021 30-Dec-2022 30-Sep-2023 31-Dec-2026 This indicator is reported annually and is on track to be met for 2023. The 2nd and 3rd phase of the data collection have been completed and the Resource Mapping and Comments: Expenditure Tracking - (RMET) report is now available. The MoHS Budget Committee will review this during the annual budget preparation before the end of the end of the calendar year. IN01347348 ►Quarterly reports produced by the Unified financial management reporting system and reviewed at national level (Number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 3.00 4.00 Date 25-Oct-2021 30-Dec-2022 30-Sep-2023 31-Dec-2026 Comments: This indicator is on track to be met for 2023. Reports for the first three quarters (January - September) e have been produced and sent to the Accountant General’s Department. 12/20/2023 Page 7 of 9 The World Bank Implementation Status & Results Report Sierra Leone - Quality Essential Health Services and Systems Support Project (P172102) Definition: Number of quarterly reports produced by unified reporting system and reviewed at national level at DFR Overall Comments IR Data reported under the RF is up to September 2023. This includes preliminary results for the most recent quarter (July-September 2023) which are still being validated through field visits and discussions with the implementing partners. Data for indicators reported annually is not available at the time of reporting. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P172102 IDA-D9380 Effective USD 40.00 40.00 0.00 3.50 34.25 9.3% P172102 TF-B7266 Effective USD 10.00 10.00 0.00 1.79 8.21 18% P172102 TF-B7267 Effective USD 10.00 10.00 0.00 3.67 6.33 37% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P172102 IDA-D9380 Effective 09-Dec-2021 16-Dec-2021 15-Mar-2022 31-Dec-2027 31-Dec-2027 P172102 TF-B7266 Effective 15-Dec-2021 16-Dec-2021 15-Mar-2022 30-Jun-2025 30-Jun-2025 P172102 TF-B7267 Effective 15-Dec-2021 16-Dec-2021 15-Mar-2022 30-Jun-2025 30-Jun-2025 Cumulative Disbursements 12/20/2023 Page 8 of 9 The World Bank Implementation Status & Results Report Sierra Leone - Quality Essential Health Services and Systems Support Project (P172102) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 12/20/2023 Page 9 of 9