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: 9 | ARCHIVED on 09-Jul-2022 | ISR51400 | Created by: Courtney Price Ivins on 11-May-2022 | Modified by: Courtney Price Ivins on 07- Jul-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 May 16 to 27, 2022 and regular virtual meetings. Despite continued challenges associated with COVID-19, the Program has contributed to achieving important results in the health sector in a range of critical areas. The Ministry of Health (MISAU) reported that the number of lagging districts reaching the target of 85 percent institutional deliveries increased from 28 in 2019 to 31 in 2021; couple years of protection increased from 1,722,692 in 2017 to 3,246,552 in 2021; the number of active community health workers (Agentes Polivalentes Elementares - APEs) more than doubled since the start of the Program, from 3,380 in 2017 to 7,301 in 2021; and the number of clinical staff at primary care facilities increased by 45 percent between 2017 and 2021. The implementation of facility scorecards and performance-based allocations has been rolled out in 34 district and rural hospitals and 297 health centers in high impact districts as identified in the investment case, with MISAU engaging civil society to facilitate the implementation of community scorecards in 222 of those facilities. The Ministry is expanding this initiative to over 400 facilities this year, and a memorandum of understanding was signed with UNICEF to channel Program resources to expand their access to water and sanitation. Project ratings for implementation progress, DLI achievement, and progress towards achieving the PDO are moderately satisfactory, in light of the continued challenges in key areas coupled with increased difficulty in achieving some 2021 targets, some of which required doubling coverage of complex services in target areas. With support from the Program, MISAU is working to address challenges to: (i) accelerate the roll out of the Nutrition Intervention Package and the package of sexual and reproductive health services in secondary schools; (ii) develop reforms to improve the quality of APE services; and (iii) coordinate with the Ministry of Economy and Finance to ensure maintenance and growth of domestic financing for health. It was also noted the COVID-19 has continued to put significant pressure on essential health service continuity and resulted in supply chain disruptions for critical inputs, while attenuating the capacity of MISAU.  The implementation of the Program Action Plan (PAP) requires continued support, particularly for strengthening the health system’s grievance redress mechanisms and actions on pharmaceuticals disposal.  Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed 7/9/2022 Page 1 of 26 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 67.81 11.52 85% P163541 TF-A6152 Effective USD 25.00 25.00 0.00 16.45 8.55 66% 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 900,000.00 200,000.00 22 % 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 7/9/2022 Page 2 of 26 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 1,923,750.00 30 % 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 0.00 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 7/9/2022 Page 3 of 26 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. Analysis is supported through (1) an ASA, and will be updated with the Investment Case final evaluation, and (2) Comments resource mapping and expenditure tracking exercises. 7/9/2022 Page 4 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) IC/PES Alignment: (ii) Provincial Program Contracts reviewed and updated annually with PES, including Action Description disaggregated DLI and results framework indicators. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems DPC Recurrent Yearly In Progress Completion Measurement Provincial Program Contracts updated annually. Comments Program Contracts were completed and shared, but require updating. Annual accounts of the health Economic and Social Plan (PES) audited within 12 months after the end of the fiscal Action Description year by the Administrative Tribunal; Resulting action plan produced, implemented, and reported on annually. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MOH -DAF Recurrent Yearly In Progress (i) Audit Report Completion Measurement (ii) Report on Action Plan implementation The 2019 Financial Audit was provided per the revised deadline and action plans are under implementation. The Comments 2020 Financial Audit was submitted with a delay of four months and is under review by the Bank. Annual procurement review of PES within 12 months of the FY's end by an independent firm, covering regulatory Action Description compliance, performance, and VFM; Action plans implemented and reported on; Remedies against ineligible expenditures and misprocurement. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MISAU & WB Recurrent Yearly In Progress (i) Audit Report (n-1) Completion Measurement (ii) Report on Action Plan implementation Procurement Reviews covering the entire health sector were finalized for 2016, 2017, 2018, and 2019 with action Comments plans under implementation. The review for 2020 was submitted. Missing information was requested. A final version will be sent by June 30 Annual updates on the implementation of the medium-term capacity development plan for the fiduciary staff at Action Description central, provincial, and district levels, including for ADUS. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MISAU (DAF) Recurrent Yearly In Progress Completion Measurement Annual report on the implementation of the capacity development plan. Comments Training plan developed and under implementation. 7/9/2022 Page 5 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) A roll-out plan developed to implement direct facility financing (ADUS), including training on the Financial Action Description Management Manual and disbursement method for each facility. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems DLI 8 MISAU Due Date 31-Jan-2021 In Progress Completion Measurement Roll-out plan for ADUS implementation. The roll-out was implemented in 297 health centers and 34 district hospitals in 2021, to be expanded to over 400 Comments health centers and all district hospitals in 2022. The ADUS manual is also being revised to include non-performance based financing. An Environmental Health Training Plan (including the EIA process, Waste Management, and Infection Prevention and Action Description Control) and a monitoring tool developed and updated semi-annually. Source DLI# Responsibility Timing Timing Value Status Environmental and Social DSA Recurrent Semi-Annually In Progress Systems Semi-annual updates on the implementation of the Environmental Health Training Plan and Monitoring Tool, including Completion Measurement semi-annual scorecard results, submitted to the World Bank. Comments Plan and monitoring tool developed and under implementation. Gender and socio-cultural responsiveness (I): Engagement of a social development specialist to: (i) provide oversight Action Description for gender and socio-cultural sensitivity in the sector; (ii) lead the review and enhancement of complaint handling mechanisms Source DLI# Responsibility Timing Timing Value Status Environmental and Social MISAU Due Date 29-Mar-2019 Completed Systems PAP IR Completion Measurement ToR developed and agreed with the Bank Social Development Specialist engaged Comments Gender and socio-cultural responsiveness (II): Ensure approaches to gender and socio-cultural sensitivity are Action Description reflected in the curriculum and training of community health workers and health staff and supported by appropriate materials. Source DLI# Responsibility Timing Timing Value Status MISAU DRH, DSNP Environmental and Social and MOH's Gender Recurrent Continuous In Progress Systems Unit Completion Measurement PAP IR; 7/9/2022 Page 6 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Curriculum; Training materials available at health centers and district/rural hospitals; and Number of trained staff in general and per province. The guiding material has been developed, reproduced, and distributed, and trainings were initiated. Additional training Comments and support packages are under development. A three-year plan identifying and addressing gaps and needs for improving the health system's GRM developed and Action Description implemented, including clear flows of information, accountability, and triage mechanisms. Source DLI# Responsibility Timing Timing Value Status Environmental and Social MOH (DNSP, Recurrent Yearly In Progress Systems DNAM) PAP IR Completion Measurement Annual reporting on GRM strengthening and results on nature and number of complaints registered and resolved. GRM strengthening mechanisms are implemented through health user desks, and reports are produced. Further Comments technical assistance is to be provided to strengthen systems for triage, monitoring, and response from different entry points. Action Description CMAM to retain a Pharmaceutical Waste Management specialist at all times during the duration of the program. Source DLI# Responsibility Timing Timing Value Status Environmental and Social CMAM Recurrent Continuous In Progress Systems Completion Measurement Pharmaceutical Waste Management Specialist hired and retained. Comments An annual national report on pharmaceutical waste management produced by CMAM based on terms of reference Action Description agreed with the World Bank Source DLI# Responsibility Timing Timing Value Status Environmental and Social CMAM Recurrent Yearly In Progress Systems Completion Measurement Annual reports on pharmaceutical waste management. Comments Annual report provided in June 2021. Next report to be provided by June 30, 2022 7/9/2022 Page 7 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 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 Environmental and Social CMAM Due Date 31-Mar-2022 Revised Date Systems Completion Measurement Stakeholder Engagement Plan completed and monitored. Comments Pending completion. Establish, implement, and regularly monitor of an action plan to improve eSIP, including the integration of community Action Description health workers. Source DLI# Responsibility Timing Timing Value Status Technical DLI 7 MISAU - DHR Recurrent Semi-Annually In Progress Completion Measurement Semi-annual updates on the action plan for eSIP improvement. Comments Contracting of technical assistance is being finalized. Develop a plan to gradually incorporate contracted personnel to the civil service and regularly report reductions in Action Description contracted staff (fora do quadro) in primary health care facilities. Source DLI# Responsibility Timing Timing Value Status Technical DLI 7 MISAU - DHR Recurrent Semi-Annually In Progress Completion Measurement Semiannual reports on fora do quadro personnel in primary health care facilities. MISAU reported that by December 2020, 578 contractors paid by Program funds in primary facilities had been Comments incorporated into the civil service; 345 were incorporated by December 2021, and 155 have yet to be incorporated. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial 7/9/2022 Page 8 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Environment and Social Substantial Substantial Substantial Stakeholders Substantial Substantial Substantial Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improve utilization of RMNCAH and Nutrition in underserved areas IN01140118 ►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 32.00 37.00 Date 31-Dec-2019 31-Dec-2020 31-Dec-2020 30-Dec-2023 MISAU increased the number of districts to 32 in 2020, superseding the annual target of 29. For 2021, Comments MISAU reported that 31 districts reached the target. This data is pending validation. IN01140119 ►Number of Couple Years of Protection (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,722,692.00 3,110,000.00 3,110,723.00 3,450,000.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2020 30-Dec-2023 The 2020 target (3,190,000) was almost fully achieved.  For 2021 MISAU reported CYP of 3,246,552 (97% Comments of the 2021 target). This data is pending validation.  IN01140120 ►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 4.00 80.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2020 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.  Improve the quality of RMNCAH-N in underserved areas IN01140386 ►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 7/9/2022 Page 9 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Value 10.00 10.00 11.00 30.00 Date 31-Dec-2020 31-Dec-2020 31-Dec-2021 31-Dec-2023 In 2021, MISAU reported 11 districts meeting the target. Comments Intermediate Results Indicators by Results Areas Service delivery outputs IN01140391 ►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 62.00 59.00 66.30 Date 29-Dec-2017 31-Dec-2020 31-Dec-2020 30-Dec-2023 In 2021, MISAU reported that 63 percent of pregnant women had at least four antenatal visits during their pregnancy. Comments In 2020, MISAU reported that 59 percent of pregnant women had at least four antenatal visits during their pregnancy (this figure is corrected from the last ISR). IN01140400 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 16,107,814.00 21,882,810.00 19,760,000.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2021 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 Comments in health facilities. These figures are added to those attained in 2018, 2019, and 2020 for a cumulative annual result. IN01140401 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,110,066.00 4,111,493.00 5,100,000.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2021 30-Dec-2023 IN01140404 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 9,637,548.00 13,178,179.00 9,720,000.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2021 30-Dec-2023 IN01140406 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) 7/9/2022 Page 10 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,360,200.00 4,593,138.00 4,940,000.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2021 30-Dec-2023 IN01140407 ►Number of provinces meeting annual Couple Years of Protection growth targets (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7.00 9.00 11.00 11.00 Date 31-Dec-2019 31-Dec-2020 31-Dec-2021 30-Dec-2023 Comments Service readiness and availability IN01140392 ►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. IN01140397 ►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. IN01140405 ►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 0.00 80.00 Date 31-Dec-2018 31-Dec-2018 31-Dec-2018 30-Dec-2023 In 2019, MISAU reported 233 (32%) of 710 secondary and technical schools received sexual and reproductive health (SRH) services. However, only 55.76% of a sample of 52 schools (22%) documented meeting all the criteria (including the provision of contraceptive methods, counseling, community Comments engagement through school councils, and monitoring). In 2020, MISAU reported meeting the target of 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.  7/9/2022 Page 11 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) In 2021, MISAU reported that 38% of secondary and technical offered SRH services. This is pending verification. IN01140408 ►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 62.00 85.00 Date 31-Dec-2018 31-Dec-2018 31-Dec-2018 29-Dec-2023 Updated survey data for this indicator (DLI 12) is not yet available. Comments Human Resources for Health (HRH) IN01140390 ►Number of active community health workers (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3,380.00 6,690.00 6,690.00 8,800.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2020 30-Dec-2023 In 2021, MISAU reported that 7,301 APEs were active, pending verification. Comments IN01140396 ►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 15,923.00 18,163.00 Date 29-Dec-2017 30-Jun-2021 30-Jun-2021 30-Dec-2023 By December 2021, MISAU reported increasing the number of technical health personnel assigned to the Comments primary health care network to 17,319 (pending verification). IN01140402 Number of technical staff assigned to type II rural health centers (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 3,787.00 6,608.00 6,608.00 6,325.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2020 30-Dec-2023 IN01140403 ►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 638.00 698.00 698.00 838.00 Date 31-Dec-2018 30-Jun-2021 30-Jun-2021 30-Dec-2023 By December 2021, MISAU reported increasing the number of primary health care facilities that have at Comments least two maternal child health nurses to 749 (pending verification). 7/9/2022 Page 12 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Quality IN01140389 ►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 15.00 44.00 Date 29-Dec-2017 31-Dec-2019 31-Dec-2019 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 a ssessments. In 2020, 15 district and rural hospitals received PBA based on prioritized action plans  (the 2020 disburse ment-linked result (DLR), following the suspension of Comments scorecard evaluations due to COVID-19). In 2021, MISAU reported t hat 34 district and rural hospitals (77%) received PBA based on at least one scorecard assessment (superseding the target of 31). This result is pending verification.  IN01140395 ►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 0.00 138.00 138.00 391.00 Date 29-Dec-2017 31-Dec-2019 31-Dec-2019 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. Comments In 2020,186 health centers received performance-based allocations based on prioritized action plans (the 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.  IN01140399 ►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-2020 31-Dec-2021 30-Dec-2023 Comments Health Financing IN01140388 ►Domestic health expenditures as a percentage of total domestic government expenditures (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7.90 9.57 9.57 9.50 7/9/2022 Page 13 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Date 29-Dec-2017 31-Dec-2020 31-Dec-2020 30-Dec-2022 In 2021, MISAU reported a result of 8.8% (below the target of 9.5%). This result in pending validation. Comments IN01140394 ►Health sub-account expenditures in 3 historically underserved provinces (Nampula, Zambezia, and Tete) (Amount(USD), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,010,000.00 3,010,000.00 36,000,000.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2020 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 Comments target of $9M, but under the 2021 target of $18M). This DLI will be revised through Program restructuring. IN01140398 ►Health sub-account expenditures in 28 historically underserved districts (Amount(USD), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 620,000.00 620,000.00 16,000,000.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2020 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. Information for decision making IN01140387 ►Percentage of deaths in eligible health facilities certified by a doctor or qualified clinician with cause of death coded using ICD10, and the death record captured in the SISMA MGDH (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 51.70 51.70 90.00 Date 29-Dec-2017 31-Dec-2020 31-Dec-2020 30-Dec-2023 Measurement of this indicator began in 2020. In 2021, MISAU reported a result of 62%, pending Comments verification. IN01140393 ►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 8.54 70.00 Date 31-Dec-2017 31-Dec-2020 31-Dec-2020 30-Dec-2023 Measurement of this indicator began in 2020.  In 2021, MISAU reported a result of 9.4%, pending Comments verification. Disbursement Linked Indicators DLI_IND_TABLE 7/9/2022 Page 14 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) ►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 32.00 -- 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 Comments the Investment Case, with at least 85 percent institutional deliveries. The target of 29 districts was achieved, 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). IN01140410 DLI 1.1 The Recipient has increased the percentage of institutional deliveries in the 42 lagging districts defined in the Investment Case (Outcome, 10,700,000.00, 0%) Unit of Measure: Number Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 66.10 85.43 85.43 -- Date -- 31-Dec-2019 31-Dec-2019 -- This indicator is the previous DLI 1, which was discontinued and revised from 2020 on. 2018 Target Achieved. The percentage of institutional deliveries was 86. Comments 2019 Target Achieved. The percentage of institutional deliveries was 85. ►DLI 2 The Recipient has increased the percentage of secondary and technical schools offering sexual and reproductive health services (information and contraceptive methods) (Intermediate Outcome, 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 Comments services. However, only 67.87% of the sample of 28 schools were found to meet the revised criteria.  2021 Target Almost Fully Achieved. MISAU reported that 38% of technical and secondary schools offered SRH services, pending verification. IN01140412 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 7/9/2022 Page 15 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 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 IN01140413 DLI 2.2 The Recipient has completed an identification of gaps in training materials (Process, 1,000,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No Yes Yes -- Date -- 31-Dec-2020 31-Dec-2020 -- No 2018 Target. No 2019 Target. Comments 2020 Target Achieved. IN01140414 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. IN01140415 DLI 2.4 The Recipient has approved updated training materials (Process, 1,000,000.00, 0%) Unit of Measure: Yes/No Indicator Type: 7/9/2022 Page 16 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Baseline Actual (Previous) Actual (Current) December 2023 Value No No No -- Date -- 31-Dec-2020 31-Dec-2020 -- No Target for 2018-2020 Comments 2021 Target not achieved (materials were developed but revisions were requested internally for final approval). IN01140416 DLI 2.5 The Recipient has approved updated Adolescent- and Youth-friendly Services Guidelines (Process, 1,500,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No No 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 Comments developed but are pending approval. IN01140417 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 IN01140418 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 7/9/2022 Page 17 of 26 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 2018-2021 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 3,110,723.00 -- Date -- 31-Dec-2020 31-Dec-2020 -- 2018 Target Achieved. The number of CYP reported exceeded the target. 2019 Target Achieved. The number of CYP reported exceeded the target. 2020 Target Almost Fully Achieved. The result was 3,110,723 CYP for 2020, just below the target of Comments 3,190,000.  2021 Target Almost Fully Achieved. MISAU reported CYP of 3,246,552 (97% of the target). ►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%) Comments 2021 Target partially achieved. MISAU has reported reaching coverage of 16% (well under the target of 40%). IN01140421 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 -- 7/9/2022 Page 18 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 2018 Target Achieved. The training of key personnel was completed. Comments IN01140422 DLI 4.2 The Recipient has finalized the Monitoring and Evaluation System (Process, 1,000,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value No Yes Yes -- Date -- 31-Dec-2018 31-Dec-2018 -- 2018 Target Achieved. The Monitoring and Evaluation System has been developed. Comments IN01140423 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 9.57 -- 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. Comments 2020 Target Achieved. MISAU reported that health sector expenditure exceeded the target of 9, reaching 9.57 of the actual government domestic expenditure.  2021 Target Not Achieved. MISAU reported a result of 8.8% (under the target of 9.5%). ►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%) 7/9/2022 Page 19 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 3,010,000.00 3,010,000.00 36,000,000.00 Date -- 31-Dec-2020 31-Dec-2020 -- 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 Comments 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.  IN01140426 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 0.00 620,000.00 620,000.00 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 Comments of this target is pending. However, MISAU reported that the original target for 2020 was met retroactively in 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. IN01140427 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 -- Comments No 2018 Target. No 2019 Target. 7/9/2022 Page 20 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 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%). IN01140428 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: 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%). IN01140429 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 -- 7/9/2022 Page 21 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) 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. Comments 2020 Target Achieved. 15,923 technical health personnel were mapped to primary care facilities in the eSIP 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). IN01140431 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 638.00 698.00 698.00 838.00 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 Comments database for 2020 below the target of 704, enabling partial disbursement. However, the target was surpassed 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).  ►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 15.00 -- 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. Comments No 2020 Target. 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. IN01140433 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 7/9/2022 Page 22 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 0.00 15.00 15.00 -- Date -- 31-Dec-2020 31-Dec-2020 -- No 2018 Target. No 2019 Target. 2020 Target Achieved. 15 (30 percent) district and rural hospitals received allocations based on prioritized action plans responding to scorecard evaluations was achieved.  Comments No 2021 Target. ►DLI 9 The Recipient has increased the number of health centers in priority districts receiving PBA according to 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 0.00 138.00 138.00 -- 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 Comments consultations were completed in 2020. 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. IN01140435 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 -- Comments 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. 7/9/2022 Page 23 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) No 2021 Target. ►DLI 10 The Recipient has increased the number of active Community Health Workers (Process, 15,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2023 Value 3,380.00 6,690.00 6,690.00 -- 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 Comments partial achievement in relation to the annual  target of 6,523 of 2019. 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. IN01140437 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. IN01140438 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 -- 7/9/2022 Page 24 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) No Target for 2018-2020. Comments 2021 Target Not Achieved. (DLR marked for removal in restructuring due to policy change). ►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 51.70 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 Comments coded using ICD10, and the death record captured in the SISMA MGDH in 2020. 2021 Target Partially Achieved. In 2021, MISAU reported a result of 62%, pending verification. IN01140440 DLI 11.1 The Recipient has increased the percentage of hospitals using the Hospital Data Management Module (MGDH) to generate information on causes of deaths (Process, 1,500,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2023 Value 70.00 100.00 100.00 -- Date -- 31-Dec-2018 31-Dec-2018 -- 2018 Target Achieved. Comments No Target for 2019-2021. IN01140441 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. 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%). 7/9/2022 Page 25 of 26 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) No 2020 Target.  No 2021 Target. IN01140442 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 8.54 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 Comments system (SiRCEV) within one year of their occurrence (below the target of 15%). 2021 Target Not Achieved. In 2021, MISAU reported a result of 9.4%, pending verification. ►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. Comments 2020 Target Not Assessed. 2021 Target Pending Confirmation. Updated survey data for this indicator is not yet confirmed. 7/9/2022 Page 26 of 26