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, Courtney Price Ivins Seq No: 10 | ARCHIVED on 24-Feb-2023 | ISR53794 | Created by: Sara Alexandra Dias Paulino Saija on 11-Nov-2022 | Modified by: Sara Alexandra Dias Paulino Saija on 16-Dec-2022 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 This ISR reflects findings of a mission conducted from October 31 to November 11, 2022. Overall, there have been satisfactory advances in the different areas of implementation, particularly in areas of human resources (allocation of clinical staff at the primary level), improvements in the quality of services, growth of the fiscal space, notable increase in the number of APEs and in the institutional deliveries. Program ratings for implementation progress, disbursement-linked indicator (DLI) achievement, and progress towards achieving the Program Development Objective (PDO) are moderately satisfactory. To date, the Program has shown important developments in various areas, such as an improvement in the utilization of the RMNCAH and Nutrition services reaching 34 of the 42 districts previewed, more specifically, an increase in the number of districts with 85% or more of institutional deliveries, number of couple years of protection (from 1,722,692 in 2018 to 3,110,723 in 2020 and 2,171,928 in 2022 ). The program has also noted an augmentation in the number of active APEs (currently 7,487), the number of technical health personnel assigned to the primary health care network which nearly doubled from 2017 to 2022 (11,970 to 22,086). The number of health care facilities (HFs) receiving performance based allocations (PBF) has been growing steadily since the beginning of the Program now reaching 43 HFs. The Ministry of Health is working on the challenges in the following areas to expedite Program implementation: (i) coverage of sexual and reproductive health (SRH) services in schools; (ii) coverage of the nutrition intervention package; (iii) supportive supervision and provision of work supplies for community health workers (agentes polivalentes elementares or APEs); (iv) availability of medicines; and (v) staffing at the Procurement Management Unit at the Ministry of Health. It has been agreed with the Government of Mozambique that the Program should be restructured to introduce adjustments in some DLIs. Once the Government sends a letter of request, restructuring will be processed. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed 2/24/2023 Page 1 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) P163541 IDA-D2650 Effective USD 80.00 80.00 0.00 70.90 7.81 90% P163541 TF-A6152 Effective USD 25.00 25.00 0.00 16.85 8.15 67% P163541 TF-A9398 Effective USD 44.95 44.95 0.00 41.02 3.93 91% P163541 TF-B3368 Effective USD 7.00 7.00 0.00 6.27 0.73 90% P163541 TF-B4481 Effective USD 3.00 3.00 0.00 2.44 0.56 81% 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 5,000,000.00 3,000,000.00 60 % of institutiona Achieved Recipient increased % of 2 Regular USD 2,800,000.00 Not Achieved 0.00 secondary schoo Recipient increased couple 3 Regular USD 700,000.00 Fully Achieved 400,000.00 57 % years of prot Recipient increased % Partially 4 Regular USD 1,000,000.00 560,000.00 56 % childreen between Achieved Recipient increased Partially 5 Regular USD 2,900,000.00 1,900,000.00 66 % Domestic Heatlh Expe Achieved Recipient increased health 6 Regular USD 2,500,000.00 Not Achieved 0.00 expenditures Recipient increased nr Partially 7 Regular USD 900,000.00 600,000.00 67 % 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 1,333,333.00 78 % rural health cente Achieved Recipient increased % of Partially 11 Regular USD 5,000,000.00 2,801,823.00 56 % deaths certifie Achieved Loan: IDAD2650-001 2/24/2023 Page 2 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Recip incrsd no of distr of Partially 1 Regular XDR 6,555,000.00 5,985,000.00 91 % the 42 laggi Achieved Recipient incr % sec&tech 2 Regular XDR 3,491,250.00 Not Achieved 0.00 sch offering s Recip increased couple Partially 3 Regular XDR 2,992,500.00 2,627,508.00 88 % years of protecti Achieved Recipient increased % Partially 4 Regular XDR 6,768,750.00 2,422,500.00 36 % children 0-24 Mon Achieved 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 6,198,750.00 Not Achieved 0.00 expenditures Recipient increased nr Partially 7 Regular XDR 6,483,750.00 4,346,250.00 67 % technical health Achieved Recipient district/rural Partially 8 Regular XDR 6,555,000.00 5,486,250.00 84 % hospitals Achieved 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 712,500.00 Fully Achieved 712,500.00 100 % Trained active CH % of deaths in elig health Partially 11 Regular XDR 3,776,250.00 2,825,649.00 75 % facilities ce Achieved Loan: TFA9398-001 Recipient increase the % 1 Regular USD 3,800,000.00 Fully Achieved 3,800,000.00 100 % of institutiona Recipient increased % of Partially 2 Regular USD 4,000,000.00 2,000,000.00 50 % secondary schoo Achieved Recipient increased couple Partially 3 Regular USD 8,900,000.00 8,801,847.00 99 % years of prot Achieved Recipient increased % Partially 4 Regular USD 3,400,000.00 1,273,333.00 37 % childreen between Achieved Recipient increased 5 Regular USD 1,500,000.00 Fully Achieved 1,500,000.00 100 % Domestic Heatlh Expe Recipient increased health 6 Regular USD 750,000.00 Not Achieved 0.00 expenditures Recipient increased nr 7 Regular USD 2,300,000.00 Fully Achieved 2,300,000.00 100 % Technical health Recipient demostrated 8 Regular USD 3,800,000.00 Fully Achieved 3,800,000.00 100 % district/ rural ho Recipient demostrated Partially 9 Regular USD 4,700,000.00 3,533,333.00 75 % rural health cente Achieved Recipient increased % of Partially 10 Regular USD 2,500,000.00 2,500,000.00 100 % deaths certifie Achieved Recipient increased % Partially 11 Regular USD 3,800,000.00 3,265,823.00 86 % deaths certified d Achieved 2/24/2023 Page 3 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Recipient increased 12 Regular USD 5,500,000.00 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 Loan: TFB4481-001 The Recip has increased Partially 7 Regular USD 2,000,000.00 1,437,500.00 72 % the No of Techi Achieved The Recip has increased 8 Regular USD 1,000,000.00 Fully Achieved 1,000,000.00 100 % the No of distri 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. The MTR was cancelled due to administrative delays. The final evaluation of the Investment Case is under Comments preparation. 2/24/2023 Page 4 of 28 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 Completed Completion Measurement Provincial Program Contracts updated annually. Comments Program Contracts were completed and signed with delay. Annexes for the revised targets shared with the Bank. 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 Comments Last years' audit submitted and monitoring is ongoing. Next audit report will be submitted by December 31, 2022. 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 Comments MISAU shared the documentation for the start of the procurement review for 2022. 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. Updated plan to be shared with the Bank. 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. 2/24/2023 Page 5 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 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. Comments Guidelines updated. 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. Plan and monitoring tool developed and under implementation. Trainings conducted, reports to be shared with the Comments Bank by December 31, 2022. 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 Plan completed. Drafting of the Gender Manual is ongoing. 780 officials and health care providers trained on GBV Comments and human rights. 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; Training materials available at health centers and district/rural hospitals; and 2/24/2023 Page 6 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Number of trained staff in general and per province. Social evaluation of vulnerable groups will be conducted until December 2022. An evaluation on social impact Comments including GBV and gender, including social management plan will be conducted by December 31, 2022. GBV response action plan by March 2023. 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. There are currently 357 User's Cabinets, 71 being physical. A total of 3712 complaints were registered, of which 89% Comments were processed (3097 with solution). 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 Completed 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 shared with the Bank. 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. Source DLI# Responsibility Timing Timing Value Status 2/24/2023 Page 7 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Environmental and Social CMAM Due Date 31-Mar-2022 Completed 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 Technical assistance hired. 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 Completed Completion Measurement Semiannual reports on fora do quadro personnel in primary health care facilities. Comments Absorbed the 155 that were missing in 2021. 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 -- -- -- Overall Substantial Substantial Substantial 2/24/2023 Page 8 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Results PDO Indicators by Objectives / Outcomes Improve utilization of RMNCAH and Nutrition in underserved areas IN01214217 ►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 30-Nov-2022 30-Dec-2023 MISAU increased the number of districts to 32 in 2020, superseding the annual target of 29. For 2021, MISAU reported that 31 districts reached the target. This data is pending validation currently being undertaken. Comments For 2022, MISAU reported having reached 34 of the 42 districts previewed. This result is pending validation and will be assessed during the next validation exercise. IN01214218 ►Number of Couple Years of Protection (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,722,692.00 3,110,723.00 2,171,928.00 3,450,000.00 Date 29-Dec-2017 31-Dec-2020 30-Nov-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.  For 2022, MISAU reported CYP of 2.171.928 (61.3% of Comments the 2022 target), result pending validation. IN01214219 ►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 16.00 80.00 Date 29-Dec-2017 31-Dec-2020 30-Sep-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 Comments validation. MISAU has hired an NGO to support execution for 2022. The end target will be revised through restructuring.  For 2022, MISAU reported a coverage of 16% until end of September (target for 2022 was 40%). Improve the quality of RMNCAH-N in underserved areas IN01214220 ►Number of lagging districts (as defined in the IC) that provide four doses of intermittent preventive treatment of malaria to at least 70 percent of pregnant women (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 11.00 11.00 30.00 2/24/2023 Page 9 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Date 31-Dec-2020 31-Dec-2021 30-Nov-2022 31-Dec-2023 In 2021, MISAU reported 11 districts meeting the target. Comments The coverage for 2022 was reported as being 11 districts, therefore, the target has been met. Intermediate Results Indicators by Results Areas Service delivery outputs IN01214250 ►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 67.00 66.30 Date 29-Dec-2017 31-Dec-2020 30-Nov-2022 30-Dec-2023 In 2021, MISAU reported that 63 percent of pregnant women had at least four antenatal visits during their pregnancy. This result is pending validation. 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 percent (target for this year was 66.3 percent). This result will be verified in the next validation exercise. IN01214259 ►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 26,210,316.00 19,760,000.00 Date 29-Dec-2017 31-Dec-2021 30-Nov-2022 30-Dec-2023 In 2021, an additional: (i)1,001,427 children were completely immunized; (ii) 3,540,631 children 12-59 months of age received deworming tablets (basic nutrition services); and (iii) 1,232,938 deliveries occurred in health facilities. These figures are added to those attained in 2018, 2019, and 2020 for a cumulative annual result. Comments For 2022, the following were reported: (i) 655,818 children completely immunized; (ii) 2,680,924 children 12-59 months of age received deworming tablets (basic nutrition services); and (iii) 990,714 deliveries occurred in health facilities. The above figures are added to those attained in the previous years, for a cumulative annual result. IN01214260 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,111,493.00 4,767,311.00 5,100,000.00 Date 29-Dec-2017 31-Dec-2021 30-Nov-2022 30-Dec-2023 IN01214263 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 2/24/2023 Page 10 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Date 29-Dec-2017 31-Dec-2021 30-Nov-2022 30-Dec-2023 IN01214265 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 5,583,852.00 4,940,000.00 Date 29-Dec-2017 31-Dec-2021 30-Nov-2022 30-Dec-2023 IN01214267 ►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 30-Nov-2022 30-Dec-2023 Comments Service readiness and availability IN01214251 ►Number of health facilities providing Basic Emergency Obstetric and Newborn Care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 68.00 68.00 68.00 300.00 Date 30-Dec-2014 30-Dec-2014 30-Dec-2014 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. This indicator will be Comments removed during the upcoming Program restructuring. IN01214256 ►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 33.00 60.00 Date 30-Dec-2014 30-Dec-2014 30-Dec-2014 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. IN01214264 ►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 80.00 Date 31-Dec-2018 31-Dec-2018 30-Nov-2022 30-Dec-2023 2/24/2023 Page 11 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) In 2019, MISAU reported 233 (32%) of 710 secondary and technical schools received 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. To be verified during next exercise. IN01214266 ►Average availability of tracer essential maternal and reproductive health medicines at primary health care facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.00 62.00 0.00 85.00 Date 31-Dec-2018 31-Dec-2018 30-Nov-2022 29-Dec-2023 Updated survey data for this indicator (DLI 12) is not yet available. A Survey was conducted by INS in 2021, and reviewed results were shared in 2022, with very low results on the availability of medicines. A revised version of the survey showed an improvement after inclusion of on Comments shelves, but still did not meet the target. The actual percentage of health facilities meeting the target is still not available. Human Resources for Health (HRH) IN01214249 ►Number of active community health workers (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3,380.00 6,690.00 7,487.00 8,800.00 Date 29-Dec-2017 31-Dec-2020 30-Nov-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 only 147, totaling 7,487 which does not meet the target Comments defined. IN01214255 ►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 22,086.00 18,163.00 Date 29-Dec-2017 30-Jun-2021 30-Sep-2022 30-Dec-2023 By December 2021, MISAU reported increasing the number of technical health personnel assigned to the primary health care network to 17,319 (pending verification). Comments By September 2022, MISAU reported an increase in the number of technical health personnel assigned to the primary health care network to 22,086 (to be verified in the next validation exercise). IN01214261 Number of technical staff assigned to type II rural health centers (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 2/24/2023 Page 12 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Value 3,787.00 6,608.00 7,828.00 6,325.00 Date 29-Dec-2017 31-Dec-2020 30-Nov-2022 30-Dec-2023 IN01214262 ►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 638.00 698.00 869.00 838.00 Date 31-Dec-2018 30-Jun-2021 30-Nov-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 IN01214248 ►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) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.00 43.00 44.00 Date 29-Dec-2017 31-Dec-2019 30-Sep-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). In 2021, MISAU reported t hat 34 district and rural hospitals (77%) Comments received PBA based on at least one scorecard assessment (superseding the target of 31). This result is pending verification.  By September 2022, MISAU reported that 43 out of 44 district and rural hospitals received PBA based on at least one scorecard assessment. IN01214254 ►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 30-Nov-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.  IN01214258 2/24/2023 Page 13 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) ►Percentage of pregnant women who receive four doses of intermittent preventive treatment of malaria during their pregnancy (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 59.00 59.00 70.00 Date 31-Dec-2019 31-Dec-2021 30-Nov-2022 30-Dec-2023 Comments Health Financing IN01214247 ►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 10.90 9.50 Date 29-Dec-2017 31-Dec-2020 30-Nov-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 10.9%, which means that the 2021 target was retrospectively achieved. Comments This result will be verified at the next validation exercise. IN01214253 ►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 18.39 36,000,000.00 Date 29-Dec-2017 31-Dec-2020 30-Sep-2022 30-Dec-2023 Data is pending verification, but MISAU reported that the 2020 target was met retroactively in 2021, with $12.01M executed in the three disadvantaged provinces from the Program Sub Account (well over the 2020 target of $9M, but under the 2021 target of $18M). This DLI will be revised through Program restructuring. Comments By September 2022, MISAU reported an expenditure of 18,390,000) in the 3 historically underserved provinces (Nampula, Zambezia, and Tete) , retrospectively achieving the target for 2021, however not meeting the target for 2022 (27,000,000). IN01214257 ►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 4,404,692.12 16,000,000.00 Date 29-Dec-2017 31-Dec-2020 30-Sep-2022 30-Dec-2023 Data is pending verification, but MISAU reported that the 2020 target was met retroactively in 2021, with $4.4M executed in the 28 disadvantaged districts from the Program Sub Account (over the 2020 target of Comments $4M, but under the 2021 target of $8M). This DLI will be revised through Program restructuring. By September 2022, MISAU reported an expenditure of $4.40M, well under the target of $12M. Information for decision making IN01214246 ►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) 2/24/2023 Page 14 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 51.70 53.70 90.00 Date 29-Dec-2017 31-Dec-2020 30-Sep-2022 30-Dec-2023 Measurement of this indicator began in 2020. In 2021, MISAU reported a result of 62%, pending verification. Comments By September 2022, MISAU reported a result of 53.7% which will be verified in the next verification exercise. IN01214252 ►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 8.84 70.00 Date 31-Dec-2017 31-Dec-2020 31-Oct-2022 30-Dec-2023 Measurement of this indicator began in 2020.  In 2021, MISAU reported a result of 9.4%, pending verification. Comments By October 2022, MISAU reported as a result for this indicator 8.84%, well 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, 11,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 28.00 32.00 34.00 -- Date -- 31-Dec-2020 31-Dec-2020 -- 2018 Target Achieved. The percentage of institutional deliveries in the 42 districts was 86. 2019 Target Achieved. The percentage of institutional deliveries in the 42 districts was 85. 2020 Target Achieved. The formulation of the indicator was revised from the average percentage of institutional deliveries in the 42 lagging districts to the number of districts, out of the 42 identified as lagging in the Investment Case, with at least 85 percent institutional deliveries. The target of 29 districts was achieved, Comments with 32 districts meeting the threshold of 85 percent. 2021 Target Almost Fully Achieved. MISAU reported increasing the number of districts meeting the threshold of 85 percent institutional deliveries to 31 (versus the target of 32). 2022 Target Almost Fully Achieved. MISAU reported having reached 34 of the 42 districts previewed. This result is pending validation and will be assessed during the next validation exercise. IN01214269 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 -- 2/24/2023 Page 15 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 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, 11,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 0.00 0.00 80.00 Date -- 31-Dec-2018 31-Dec-2018 -- No 2018 Target. 2019 Target Not Achieved. MISAU reported that 32 percent of schools were offering SRH, but there was not sufficient information to validate the indicator. 2020 Target Not Achieved. MISAU reported reaching 19% of technical and secondary schools offering SRH services. However, only 67.87% of the sample of 28 schools were found to meet the revised criteria.  Comments 2021 Target Almost Fully Achieved. MISAU reported that 38% of technical and secondary schools offered SRH services, pending verification. 2022 Target Achieved. For 2022, MISAU reported that 61% (433) of secondary and technical schools offered SRH services. To be verified during next exercise. IN01214271 DLI 2.1 The Recipient has increased the percentage of technical schools offering sexual and reproductive health services (information and contraceptive methods) (Intermediate Outcome, 4,000,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 0.00 0.00 -- Date -- 31-Dec-2018 31-Dec-2018 -- This indicator is marked for removal in the restructuring. Comments IN01214272 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 -- Comments No 2018 Target. 2/24/2023 Page 16 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) No 2019 Target. 2020 Target Achieved. IN01214273 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. IN01214274 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 No -- Date -- 31-Dec-2020 31-Dec-2020 -- No Target for 2018-2020 2021 Target not achieved (materials were developed but revisions were requested internally for final Comments approval). 2022 Target not achieved (approval is pending upon submission). IN01214275 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 2/24/2023 Page 17 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Value No No No -- Date -- 31-Dec-2020 31-Dec-2020 -- No Target for 2018-2020 2021 Target Not Achieved. MISAU reported that the guidelines for adolescents and youth-friendly services are developed but are pending approval. Comments 2022 Target Not Achieved. MISAU shared the developed guidelines for adolescents and youth-friendly but informed that these are still pending approval. IN01214276 DLI 2.6 The Recipient has completed training for health providers using new 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 No -- Date -- 31-Dec-2020 31-Dec-2020 -- No target for 2018-2021 Comments IN01214277 DLI 2.7 The Recipient has trained health providers and focal points on improved monitoring and evaluation tools (Process, 1,500,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No No No -- Date -- 31-Dec-2020 31-Dec-2020 -- No Target for 2018-2021 Comments ►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 2,171,928.00 -- Date -- 31-Dec-2020 31-Dec-2020 -- Comments 2018 Target Achieved. The number of CYP reported exceeded the target. 2/24/2023 Page 18 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 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.  2021 Target Almost Fully Achieved. MISAU reported CYP of 3,246,552 (97% of the target). 2022 Target Not Achieved. For 2022 (until September), MISAU reported CYP of 2.171.928 (61.3% of the 2022 target), result pending validation. ►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, 15,750,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 4.00 4.00 80.00 Date -- 31-Dec-2020 31-Dec-2020 -- 2018: No target 2019: No target 2020 Target retroactively achieved (4%, under the target of 15%) 2021 Target partially achieved. MISAU has reported reaching coverage of 16% (well under the target of Comments 40%). 2022 Target partially achieved. MISAU reported a coverage of 16% until end of September (target for 2022 was 40%). The end target was reviewed to 40%. IN01214280 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 IN01214281 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 -- 2/24/2023 Page 19 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 2018 Target Achieved. The Monitoring and Evaluation System has been developed. Comments IN01214282 DLI 4.3 The Recipient has increased the percentage of nutrition sites meeting the minimum quality standards (Intermediate Outcome, 4,750,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 0.00 0.00 90.00 Date -- 31-Dec-2018 31-Dec-2018 -- No Target for 2018-2021. This target is marked for removal in the restructuring, as quality standards will be measured through verification Comments of the minimum criteria of the Nutrition Intervention Package roll-out. ►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 10.90 -- Date -- 31-Dec-2020 31-Dec-2020 -- 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. 2020 Target Achieved. MISAU reported that health sector expenditure exceeded the target of 9, reaching Comments 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 Target Achieved. MISAU reported a result of 10.9%, which means that the 2021 target was retrospectively achieved. This result will be verified at the next validation exercise. ►DLI 6 The Recipient has increased health expenditures from the Sub-Account Resources in underserved provinces (Nampula, Zambezia, Tete) (Process, 4,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 3,010,000.00 18,390,000.00 36,000,000.00 Date -- 31-Dec-2020 31-Dec-2020 -- Comments No 2018 Target. No 2019 Target. 2020 Target Retroactively Achieved. MISAU reported that US$3 million of resources from the Program's Sub-Account have been executed by the three underserved provinces (significantly less than previously reported). However MISAU reported that the original target for 2020 was met retroactively in 2021, with $12.01M executed in the three disadvantaged provinces from the Program Sub Account (well over the 2020 target of $9M, but under the 2021 target of $18M). This DLI will be revised through Program restructuring. 2021 Target Not Achieved.  2/24/2023 Page 20 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 2022 Target Not Achieved. MISAU reported an expenditure of 18,390,000) in the 3 historically underserved provinces (Nampula, Zambezia, and Tete) , retrospectively achieving the target for 2021, however not meeting the target for 2022 (27,000,000). IN01214285 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, 4,000,000.00, 0%) Unit of Measure: Amount(USD) Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 620,000.00 4,404,692.12 16,000,000.00 Date -- 31-Dec-2020 31-Dec-2020 -- No 2018 Target. No 2019 Target. 2020 Target Retroactively Achieved.  MISAU reported that US$620,000 of resources from the Program's Sub- Account were executed by the 28 underserved districts in 2020 (less than previously reported). The verification of this target is pending. However, MISAU reported that the original target for 2020 was met retroactively in Comments 2021, with $4.4M reported as executed in the 28 underserved districts from the Program Sub Account (vs. the 2020 target of $4M). 2021 Target Not Achieved. 2022 Target Not Achieved. MISAU reported an expenditure of $4.40M, well under the target of $12M. IN01214286 DLI 6.2 The Recipient has maintained Domestic Health Expenditures for the three underserved provinces (Nampula, Zambezia, Tete) as a share of provincial expenditures (Process, 2,000,000.00, 0%) Unit of Measure: Amount(USD) Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 36.60 35.60 35.60 36.60 Date -- 31-Dec-2020 31-Dec-2020 -- No 2018 Target. No 2019 Target. Comments 2020 Target Almost Achieved (reported as 3 5.5% vs. the target of 36.6%). 2021 Target Not Achieved (reported as 33%, vs. the target of 36.6%). IN01214287 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 expenditures (Process, 2,000,000.00, 0%) Unit of Measure: Amount(USD) Indicator Type: 2/24/2023 Page 21 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Baseline Actual (Previous) Actual (Current) December 2023 Value 19.50 15.40 15.40 19.50 Date -- 31-Dec-2020 31-Dec-2020 -- No 2018 Target. No 2019 Target. Comments 2020 Target Not Achieved (reported as 15.4% vs. the target of 19.5%). 2021 Target Not Achieved (reported as 18%, vs. the target of 19.5%). IN01214288 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: Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 0.00 0.00 -- Date -- 31-Dec-2019 31-Dec-2019 -- No 2018 Target. No 2019 Target. Comments 2020-2021 Targets Achieved. All 11 Program Contracts, signed in 2021, were shared. Updates are underway. ►DLI 7 The Recipient has increased the number of technical health personnel assigned to the primary health care network (Process, 12,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 11,970.00 15,923.00 15,923.00 18,163.00 Date -- 30-Jun-2021 30-Jun-2021 -- 2018 Target Achieved. The number of technical personnel assigned to the primary network was 13,666 (from a total of 14,367 assigned, deducting 701 on long-term leave). The source of the data was the SARA census of facilities conducted in August 2018. 2019 Target Retroactively Achieved. 14,402 technical health personnel were identified in the eSIP database for 2019 (excluding personnel on long-term leave or suspended), below the target of 15,432 enabling partial disbursement. However, the target was surpassed in 2020. The verification is pending. 2020 Target Achieved. 15,923 technical health personnel were mapped to primary care facilities in the eSIP Comments database for 2020 (excluding personnel on long-term leave or suspended), superseding the target of 15,566.  2021 Target Achieved. By December 2021, MISAU reported increasing the number of technical health personnel assigned to the primary health care network to 17,319 exceeding the target by 7% (pending verification). 2022 Target Achieved. MISAU reported an increase in the number of technical health personnel assigned to the primary health care network to 22,086 (to be verified in the next validation exercise). 2/24/2023 Page 22 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) IN01214290 DLI 7.1 The Recipient has increased the number of health care facilities in the primary care network with at least two active Maternal Child Health Nurses (Process, 6,000,000.00, 0%) Unit of Measure: Number Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 638.00 698.00 869.00 838.00 Date -- 31-Dec-2020 31-Dec-2020 -- No 2018 Target. 2019 Target Retroactively Achieved. 678 facilities were listed as having two or more MCH nurses in the SIP database for 2019 below the target of 688, enabling partial disbursement. However, the target was surpassed in 2020.  2020 Target Retroactively Achieved. 688 facilities were listed as having two or more MCH nurses in the SIP database for 2020 below the target of 704, enabling partial disbursement. However, the target was surpassed Comments in 2021.The verification is pending. 2021 Target Achieved. MISAU reported increasing the number of primary health care facilities that have at least two maternal child health nurses to 749, exceeding the target of 728 (pending verification).  2022 Target Achieved. 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). ►DLI 8 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 (Process, 18,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 15.00 43.00 -- Date -- 31-Dec-2019 31-Dec-2019 -- 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 Almost Achieved. MISAU reported that 43 out of 44 district and rural hospitals received PBA based on at least one scorecard assessment. IN01214292 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 -- 2/24/2023 Page 23 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 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 one scorecard assessment with community consultations in the previous fiscal year (Process, 21,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 138.00 425.00 -- Date -- 31-Dec-2019 31-Dec-2019 -- 2018 Target Achieved. 64 Rural Health Centers received a scorecard evaluation, including community consultations, and received the respective PBA.  2019 Target Retroactively Achieved. 186 Health Centers (138 Rural Health Centers) received PBA based on two scorecard assessments in 2019. However, the community consultations did not take place in 2019 due to a delay in contracting the non-government organization in charge of organizing them. The community consultations were completed in 2020. Comments No 2020 Target. 2021 Target Partially Achieved. MISAU reported that 222 health centers received PBA based on at least one scorecard assessment, of which 229 also had community consultations conducted (leaving 32 community consultations to be conducted to reach the target 261). This result is pending verification. 2022 Target  Achieved. MISAU reported that 425 health centers received PBA based on at least one scorecard assessment. IN01214294 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: 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. 2/24/2023 Page 24 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) ►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 7,487.00 -- Date -- 31-Dec-2020 31-Dec-2020 -- 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 increased in only 147, totaling 7,487 which does not meet the target defined. IN01214296 DLI 10.1 The Recipient has increased the percentage of Community Health Workers that deliver services according to minimum quality standards (Intermediate Outcome, 7,500,000.00, 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 -- No 2018 Target. No 2019 Target. No 2020 Target. Comments 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. IN01214297 DLI 10.2 The Recipient has approved a Decree recognizing Community Health Workers as state agents of the National Health System (Process, 3,500,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No No No -- Date -- 31-Dec-2020 31-Dec-2020 -- Comments No Target for 2018-2020. 2/24/2023 Page 25 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 2021 Target Not Achieved. (DLR marked for removal in restructuring due to policy change). 2022 No Target. ►DLI 11 The Recipient has increased the percentage of deaths in eligible health facilities certified by a qualified clinician with the cause of death coded using ICD10, and the death record captured in SISMA (Process, 10,240,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 51.70 53.70 90.00 Date -- 31-Dec-2020 31-Dec-2020 -- No 2018 Target. No 2019 Target. 2020 Target Achieved. 51.7% of deaths in eligible health facilities were certified with the cause of death coded using ICD10, and the death record captured in the SISMA MGDH in 2020. Comments 2021 Target Partially Achieved. In 2021, MISAU reported a result of 62%, pending verification. 2022 Target Not Achieved. MISAU reported a result of 53.7% which will be verified in the next verification exercise. IN01214299 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. No Target for 2019-2021. Comments No Target 2019-2022. IN01214300 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 No 2018 Target. 2/24/2023 Page 26 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 2018 Target Achieved. 2019 Target Partially Achieved. 77.6% of health centers with internment (97 out of 125) were using MGDH to generate information on causes of death (below the target of 100%). No 2020 Target.  No 2021 Target. No 2022 Target. IN01214301 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, 2,060,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 8.54 8.84 70.00 Date -- 31-Dec-2020 31-Dec-2020 -- No 2018 Target. 2019 Target Not Yet Assessed. 2020 Target Partially Achieved. 8.54% of deaths were registered, certified and captured in the civil registration system (SiRCEV) within one year of their occurrence (below the target of 15%). Comments 2021 Target Not Achieved. In 2021, MISAU reported a result of 9.4%, pending verification. 2022 Target Not Achieved. MISAU reported as a result for this indicator 8.84%, well below the target of 25% for this year. ►DLI 12 The Recipient has increased the average availability of tracer essential maternal and reproductive health medicines at primary health care facilities (Outcome, 10,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 62.00 62.00 62.00 -- Date -- 31-Dec-2018 31-Dec-2018 -- No 2018 Target. 2019 Target Not Assessed. 2020 Target Not Assessed. 2021 Target Pending Confirmation. Updated survey data for this indicator is not yet confirmed. Comments 2022 Target Pending Confirmation. The survey results were shared in 2022, with very low results on the availability of medicines. A revised version of the survey showed an improvement after inclusion of on shelves, but still did not meet the target. The actual percentage of HFs meeting the target is still not available. 2/24/2023 Page 27 of 28 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 2/24/2023 Page 28 of 28