Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Essential Health Services Access Project (P149960) EAST ASIA AND PACIFIC | Myanmar | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2015 | Seq No: 5 | ARCHIVED on 12-Jan-2017 | ISR26187 | Implementing Agencies: Ministry of Health Key Dates Key Project Dates Bank Approval Date:14-Oct-2014 Effectiveness Date:08-Apr-2015 Planned Mid Term Review Date:25-Sep-2017 Actual Mid-Term Review Date:-- Original Closing Date:30-Jun-2019 Revised Closing Date:30-Jun-2019 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to increase coverage of essential health services of adequate quality, with a focus on maternal, newborn and child health (MNCH). 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)PHRPDODEL The Project Development Objective (PDO) is to increase coverage of essential health services of adequate quality, with a focus on maternal, newborn and child health (MNCH), and, in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency. Components Name Component 1: Strengthening Service Delivery at the Primary Health Care Level:(Cost $84.00 M) Component 2: Systems Strengthening, Capacity Building, and Project Management Support:(Cost $12.57 M) Component 3: Contingent Emergency Response:(Cost $3.43 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Satisfactory Overall Risk Rating  High  High 1/12/2017 Page 1 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Implementation Status and Key Decisions The mission commends the leadership of MOHS on the formulation of the National Health Plan (NHP). The preparation of the NHP was inclusive and transparent, and has been built on emerging evidence. The core objective of NHP is to define a strategic direction for achieving universal access to essential primary health care services. WBG is pleased to note that the framing of NHP is built around the importance of implementation feasibility and priority setting, and that NHP process explicitly addresses the weakness of many national plans, which are often compilation of dis-jointed and uncoordinated program activities and sometimes remain a “wish list.” The key messages conveyed by MOHS about the NHP clearly resonate with the WBG—focusing on improving service delivery at the primary health care level and engaging other key stakeholders and health care providers, in moving towards the broader goal of UHC. The WBG is honored to have been able to contribute to the NHP development by participating as a representative of International Finance Institutions (IFIs), sharing implementation lessons from the ongoing IDA-financed project, EHSAP (which aims to strengthen the frontlines of service delivery at the township and below), analytical work on fiscal space, and technical assistance on defining and costing the basic essential package of health services (EPHS). Going forward, WBG stands ready to support, including the implementation of NHP through additional financing for EHSAP, Myanmar’s participation in the GFF, and mobilizing grant resources, such as GFF trust fund and PHRD. In parallel to the dialogue on support to the NHP through additional financing, the mission sought to review EHSAP and ensure its smooth and effective implementation, with the already approved IDA credit. In this regard, the WBG commends MOHS on achieving almost all of the first year targets of the DLIs (with the only exception of one DLI which reached 82% of the target). In addition, the mission was impressed with the Department of Medical Research (DMR), along with the Oversight Committee, in their conscientious undertaking of the independent verification for the first year. They submitted thoughtful recommendations and suggestions, many of which are incorporated into the next steps and actions. For Component 1, the mission also lauds MOHS for identifying implementation challenges, and seeking their resolution in close consultation with the in-country team of WBG throughout the year. It is important to note, however, that the overall implementation progress of EHSAP over the past six months has been mixed, with many planned activities stalled or experiencing severe delays, especially with respect to Component 2 and the safeguards. Therefore, MOHS and WBG have agreed on key actions needed to improve the implementation of EHSAP. They include: (i) increasing support to the state/region and township levels by ensuring adequate financial management staffing and capacity and strengthening health planning; (ii) improving implementation and monitoring of health systems strengthening activities at the central level; and (iii) obtaining technical assistance to support HCWM. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  High  High Macroeconomic  --  Substantial  Substantial Sector Strategies and Policies  --  Moderate  Moderate Technical Design of Project or Program  --  High  High Institutional Capacity for Implementation and Sustainability  --  High  High Fiduciary  --  Substantial  Substantial Environment and Social  --  High  High Stakeholders  --  Substantial  Substantial Other  --  --  -- Overall  --  High  High Results 1/12/2017 Page 2 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Project Development Objective Indicators PHINDPDOTBL  Townships in which the township hospital and at least 60% of other Health Facilities have met a minimum readiness level of 14 out of 20 to provide essential MNCH services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 50.00 300.00 Date 01-Jun-2014 31-Mar-2016 31-Oct-2016 30-Jun-2019 PHINDPDOTBL  Children under 6 months who are being exclusively breast-fed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 24.00 24.00 51.00 40.00 Date 30-Jun-2015 31-Mar-2016 31-Mar-2016 30-Jun-2019 Comments Baseline data come from a household survey conducted in 2010. DHS 2015/2016 showed that % of children under 6 months who are exclusively breast-fed was 51%. Based on this new data, the end-line will be revised based on the nutritional goal of the Government. PHINDPDOTBL  Deliveries which are followed by adequate postnatal care (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 78.00 -- 85.00 Date 01-Jun-2014 30-Sep-2015 30-Sep-2015 30-Jun-2019 PHINDPDOTBL  Deliveries with skilled birth attendant (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 71.00 76.00 76.00 82.00 Date 01-Jun-2014 31-Mar-2016 31-Oct-2016 30-Jun-2019 Comments The data provided comes from HMIS, which shows an improvement in the indicator. However, we note that the DHS 2015/2016 showed a 1/12/2017 Page 3 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) significantly lower level of deliveries by skilled birth attendant, a national average of 60%. Overall Comments The first ever Demographic and Health Survey was undertaken in 2015-2016. The preliminary report was released in October 2016, with the full report expected in early 2017. The project M&E relies on DLI reporting and HMIS data, which is collected annually by the Ministry of Health and Sports, and the DHS for PDO level indicators. Intermediate Results Indicators PHINDIRITBL  Townships where data quality assessments are carried out (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 34.00 0.00 300.00 Date 01-Jun-2014 31-Mar-2016 31-Oct-2016 30-Jun-2019 PHINDIRITBL  Townships in which the township hospital and atleast 80% of other health facilities have received Health Facility Grants in accordance with Project Operations Manual (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 50.00 300.00 Date 01-Jun-2014 30-Sep-2015 31-Oct-2016 30-Jun-2019 PHINDIRITBL  Townships where atleast 60% of the health facilities had no stock-out of supplies in the past year. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 300.00 Date 01-Jun-2014 31-Mar-2016 31-Oct-2016 30-Jun-2019 1/12/2017 Page 4 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) PHINDIRITBL  Townships in which atleast 80% of required number antenatal and postnatal visits and deliveries have been carried out by basic health staff (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 50.00 300.00 Date 01-Jun-2014 31-Mar-2016 31-Oct-2016 30-Jun-2019 PHINDIRITBL  Townships in which the Township Health Departments have prepared an integrated and inclusive Township Health Plans (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 41.00 300.00 Date 01-Jun-2014 31-Mar-2016 31-Oct-2016 30-Jun-2019 PHINDIRITBL  Essential Package of Health Services including quality standards defined, costed, approved, and publicly communicated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 01-Jun-2014 30-Mar-2016 31-Oct-2016 31-Mar-2016 PHINDIRITBL  Health Financing Strategy for UHC developed, approved, and communicated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y N Y Date 01-Jun-2014 31-Mar-2016 31-Oct-2016 31-Mar-2017 1/12/2017 Page 5 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) PHINDIRITBL  Townships in which at least 60% of midwives have been trained to deliver BeMOC and IMCI (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 50.00 300.00 Date 01-Jun-2014 31-Mar-2016 31-Oct-2016 30-Jun-2019 PHINDIRITBL  Communications strategy developed and implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 01-Jun-2014 31-Mar-2016 31-Mar-2016 30-Jun-2019 PHINDIRITBL  Townships in which all rural health centers and atleast 50% of subcenters have been supervised atleast twice in a fiscal year by Township Health Department using checklist (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 50.00 300.00 Date 01-Jun-2014 31-Mar-2016 31-Oct-2016 30-Jun-2019 PHINDIRITBL  Health Care Waste Management guidelines and policy developed and implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N N N Y Date 01-Jun-2014 31-Mar-2016 31-Oct-2016 30-Jun-2019 1/12/2017 Page 6 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) PHINDIRITBL  Township in which township health department have been supervised at least twice in a fiscal year by State/Region Health Department officials using checklist (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 50.00 300.00 Date 01-Jun-2014 31-Mar-2016 31-Oct-2016 30-Jun-2019 PHINDIRITBL  Improved supervision (supervision standards and checklists developed) (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 01-Jun-2014 30-Sep-2015 30-Sep-2015 31-Dec-2015 PHINDIRITBL  Service readiness scorecard implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 01-Jun-2014 30-Sep-2015 30-Sep-2015 30-Dec-2015 PHINDIRITBL  Improved fund flows (recurrent) to front line health facilities--Training on guidelines developed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 01-Jun-2014 01-Sep-2015 01-Sep-2015 01-Apr-2015 1/12/2017 Page 7 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) PHINDIRITBL  Goods procured and distributed as outlined in the CERIP (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N -- -- Y Date 14-Jun-2016 -- -- 14-Jun-2017 Overall Comments The intermediate indicators, which are Disbursement Linked, were independently verified in October 2016. Using this verification, data have been provided or revised accordingly. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P149960 IDA-55420 Effective XDR 65.40 65.40 0.00 28.68 36.72 44% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P149960 IDA-55420 Effective 14-Oct-2014 05-Feb-2015 08-Apr-2015 30-Jun-2019 30-Jun-2019 Cumulative Disbursements 1/12/2017 Page 8 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Restructuring History Level 2 Approved on 12-May-2015 ,Level 1 Approved on 23-Jun-2016 Related Project(s) P160208-Additional Financing: Essential Health Services Access Project 1/12/2017 Page 9 of 9 Public Disclosure Copy