The World Bank Implementation Status & Results Report Health System Performance Strengthening Project (P172504) Health System Performance Strengthening Project (P172504) WESTERN AND CENTRAL AFRICA | Chad | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2022 | Seq No: 3 | ARCHIVED on 23-Dec-2022 | ISR54123 | Implementing Agencies: Ministry of Public Health and Prevention, Republic of Chad Key Dates Key Project Dates Bank Approval Date: 06-Aug-2021 Effectiveness Date: 29-Nov-2021 Planned Mid Term Review Date: 15-Jan-2024 Actual Mid-Term Review Date: Original Closing Date: 31-Dec-2026 Revised Closing Date: 31-Dec-2026 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective is to improve the utilization and quality of service delivery of essential health services with a particular focus on reproductive, maternal, child and adolescent health, and nutrition services for the population of Chad in project-supported areas Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) To improve utilization and quality of service delivery of essential health services with a particular focus on reproductive, maternal, child and adolescent health, and nutrition services for the population of Chad in project-supported areas, and to provide immediate and effective response to an eligible crisis or emergency Components Table Name Scaling up Performance-Based Financing for better health service delivery:(Cost $147.50 M) Strengthening service delivery readiness to deliver quality RMNCAH-N services:(Cost $36.00 M) Project management and verification of results:(Cost $23.00 M) Contingent Emergency Response Component:(Cost $50.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Moderate Implementation Status and Key Decisions The project has made progress in implementation since the last supervision mission. More than 1114 health personnel from different levels of the health pyramid have already been on PBF. The first performance contracts were signed with 821 health facilities (health centers and hospitals), 56 health districts, eight (8) Provincial Health and Prevention Delegations (DPSP), 11 central directorates (including the general secretariat) as well as 12/23/2022 Page 1 of 9 The World Bank Implementation Status & Results Report Health System Performance Strengthening Project (P172504) with the National Institute of Statistics for Economic and Demographic Studies (INSEED) and its four (04) Contracting and Verification Agencies (ACV). The first payments in the form of advances were made to health districts, DPSPs, INSEED and its 4 ACVs and 590 health facilities. Verification of the production of the first quarter of implementation is being finalized, as well as the quality evaluation. Activities related to the activation of the CERC component are in progress. Contracts with United Nations agencies such as UNICEF, WFP and FAO for the purchase of nutritional and agricultural inputs have been signed. The payment process for these three contracts is ongoing and is expected to be completed by December 15, 2022. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Moderate Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and Substantial Moderate Moderate Sustainability Fiduciary High High High Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other Moderate Moderate Moderate Overall Substantial Substantial Moderate Results PDO Indicators by Objectives / Outcomes To improve the service delivery of essential health services in project-supported areas IN01239857 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 410,109.00 410,109.00 410,109.00 1,598,000.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 IN01239882 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) 12/23/2022 Page 2 of 9 The World Bank Implementation Status & Results Report Health System Performance Strengthening Project (P172504) Baseline Actual (Previous) Actual (Current) End Target Value 265,529.00 265,529.00 265,529.00 928,000.00 IN01239883 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 115,046.00 115,046.00 115,046.00 334,000.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 IN01239884 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 160,384.00 160,384.00 160,384.00 917,000.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 IN01239885 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 115,046.00 115,046.00 115,046.00 347,000.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 IN01239875 ►Average health facility score on the quality evaluation of health care using a quality checklist among facilities in the project area (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 65.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Comments: Sum of quality scores of all health facilities in the project / number of health facilities evaluated IN01239878 ►Women in the project area who are currently using any modern method of contraception (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 187,650.00 187,650.00 187,650.00 502,751.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Comments: Total Number of women in the project area who are currently using any modern method of contraception IN01239886 Girls in the project area, aged 15-19, who are currently using any modern method of contraception (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 6,101.00 6,101.00 6,101.00 20,994.00 12/23/2022 Page 3 of 9 The World Bank Implementation Status & Results Report Health System Performance Strengthening Project (P172504) Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 IN01239887 Women in the project area, aged 20-49, who are currently using any modern method of contraception (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 181,549.00 181,549.00 181,549.00 481,757.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 IN01239881 ►Pregnant women in the project area who have received at least 4 antenatal care visits from skilled health providers (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 85,023.00 85,023.00 85,023.00 274,270.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Total number of pregnant women in rural area who have received at least 4 antenatal care visits from Comments: skilled health providers To improve CERC Activity Implementation IN01239858 ►CERC implemented according to the Emergency Response Action Plan (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No -- No Yes Date 17-Nov-2022 -- 17-Nov-2022 31-Dec-2026 Intermediate Results Indicators by Components Scaling up Performance-Based Financing for better health service delivery IN01239859 ►The national population covered by the PBF program (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 12.00 12.00 12.00 45.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Comments: The population in area covered by the PBF program/ national population IN01239862 ►Supervision visits in the project area in which the digital supervision tool was fully completed (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/23/2022 Page 4 of 9 The World Bank Implementation Status & Results Report Health System Performance Strengthening Project (P172504) Value 0.00 0.00 0.00 518.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Comments: Number of supervision visits in the project area in which the digital supervision tool was fully completed IN01239866 ►Health centers in the project area which offered at least 75 percent of the package of services defined in their PBF contract (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Number of health centers in the project area which offered at least 75 percent of the package of services Comments: defined in their PBF contract/Number of health centers in the project area with PBF contract IN01239870 ►Consultations provided to the poor free of charge in the project area (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 802,740.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Comments: Total number of poor who received medical consultations free of charge in the project area IN01239871 ►Hospitals (district and provincial) in the project area that have achieved at least 80 percent of the score on the quality of maternity services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Number of hospitals (district and provincial) in the project area that have achieved at least 80 percent of Comments: the score on the quality of maternity services IN01239873 ►Health centers in the project area that had a revenue and an expense book available and up to date (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Number of health centers in the project area that had a revenue and an expense book available and up to Comments: date/Number of health facilities in project area IN01239876 ►GBV survivors who have received health care from a trained health worker at a health care facility in the project area (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 20,938.00 12/23/2022 Page 5 of 9 The World Bank Implementation Status & Results Report Health System Performance Strengthening Project (P172504) Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Comments: Total number of GBV survivors who have received health care at health facilities in the project area Strengthening service delivery readiness to deliver quality RMNCAH-N services IN01239861 ►People referred by a CHW to a health facility in the project area (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 280,958.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Total number of patients or people referred to the health facilities by community health workers in the Comments: project area IN01239864 ►CHWs in the project area who have used a digital tool to complete at least one upskilling module in the last three months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Total number of CHW who have used a digital tool to complete at least one upskilling module in the last Comments: three months IN01239867 ►Health facilities in the project area that had 100 percent of the tracer drugs available on the day of the visit (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Number of health facilities in project area with 100 percent tracer drugs available on the day of the Comments: visit/Number of health facilities in project area IN01239869 ►Personnel in the project area who have received clinical training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 516.00 516.00 516.00 2,011.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Comments: Total number of personnel who have received clinical training in the project area IN01239872 ►Children under 5 years of age in the project area that have been registered in the civil registry (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/23/2022 Page 6 of 9 The World Bank Implementation Status & Results Report Health System Performance Strengthening Project (P172504) Value 160,548.00 160,548.00 160,548.00 565,822.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Comments: Total number of children under 59 months registered in the civil registry IN01239874 ►Children 6 - 59 months of age in the project area that have received vitamin A supplement in the last six Months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 531,012.00 531,012.00 531,012.00 850,000.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Comments: Total number of children aged 6–59 months who received a vitamin A supplement in the last six Months IN01239877 ►Health facilities in the project area that have reported through DHIS2 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 30.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Numbed of health facilities in project area reporting through DHIS2/Total number of health facilities in Comments: project area reporting IN01239879 ►Grievances that will be registered and addressed as established in the PIM. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Comments: Grievances registered and addressed as established in the PIM/Total number of grievances registered . IN01239880 ►Patients who say that they are satisfied with the health services received in the project area (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 Number of the patients surveyed who say that they are satisfied with the project/Total number of patients Comments: surveyed within the project area Project management and verification of results IN01239860 ►Health facilities in the project area that have received PBF payments on time (as defined in the PBF manual) (Percentage, Custom) 12/23/2022 Page 7 of 9 The World Bank Implementation Status & Results Report Health System Performance Strengthening Project (P172504) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 01-Sep-2020 20-Oct-2021 20-Oct-2021 31-Dec-2026 number of health facilities receiving PBF payment on time (as defined in the PBF manual) in the project Comments: area/Number of health facilities with PBF contract in the project area Contingent Emergency Response Component IN01239863 ►Cartons of Plumpy'Nut procured and distributed (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 243,733.00 Date 17-Nov-2022 -- 17-Nov-2022 31-Dec-2026 IN01239865 ►Tons of Plumpy' sup procured and distributed (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 3,043.00 Date 17-Nov-2022 -- 17-Nov-2022 31-Dec-2026 IN01239868 ►Farmers reached with agricultural assets or services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 12,500.00 Date 17-Nov-2022 -- 17-Nov-2022 31-Dec-2026 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P172504 IDA-D8070 Effective USD 90.00 90.00 0.00 10.01 73.23 12% P172504 TF-B5488 Effective USD 16.50 16.50 0.00 2.16 14.34 13% Key Dates (by loan) 12/23/2022 Page 8 of 9 The World Bank Implementation Status & Results Report Health System Performance Strengthening Project (P172504) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P172504 IDA-D8070 Effective 06-Aug-2021 21-Sep-2021 29-Nov-2021 31-Dec-2026 31-Dec-2026 P172504 TF-B5488 Effective 06-Aug-2021 21-Sep-2021 29-Nov-2021 31-Dec-2026 31-Dec-2026 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) P180030-Additional Financing Chad-Health System Performance Strengthening Project ,P180039-Additional Financing-Health System Performance Strengthening Project 12/23/2022 Page 9 of 9