The World Bank Implementation Status & Results Report The Gambia Essential Health Services Strengthening Project (P173287) The Gambia Essential Health Services Strengthening Project (P173287) AFRICA WEST | Gambia, The | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2021 | Seq No: 1 | ARCHIVED on 17-Feb-2021 | ISR45033 | Implementing Agencies: The Gambia, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 09-Oct-2020 Effectiveness Date: 28-Oct-2020 Planned Mid Term Review Date: 17-Oct-2022 Actual Mid-Term Review Date: Original Closing Date: 29-Aug-2025 Revised Closing Date: 29-Aug-2025 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To improve quality and utilization of essential health services in The Gambia. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1. Improving the Delivery and Utilization of Quality Essential Primary Health Care Services:(Cost $32.00 M) Component 2. Project management:(Cost $3.00 M) Component 3. Contingent Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO -- Satisfactory Overall Implementation Progress (IP) -- Satisfactory Overall Risk Rating -- Moderate Implementation Status and Key Decisions The project was approved on October 9, 2020 and became effective on October 28, 2020. The activities in the 2021 Annual Work Program and Budget have been initiated. The essential healthcare package for each level of the health care delivery system (that is, village health services, community clinics, minor health centers, major health centers, district hospitals, general hospitals, and the teaching hospital) has been validated and finalized, and the costing of the package for all levels has been completed except for tertiary level. Further, the quality of care checklist has been administered in all regions and is expected to be administered following each quarter of calendar year 2021 to gauge progress in the provision of quality health services. Of the GMD 40 million (about US$800,000) allocated in the 2020 government budget to RBF, GMD 30 million (about US$600,000) ended up being expended since verification of the services in the last quarter of 2020 is required in January 2021 before the payment of performance-based financing (PBF) grants to the health facilities for that quarter. The MOH should actively engage the Ministry of Finance and Economic Affairs (MOFEA) to ensure full execution by December 2021 of the GMD 50 million (about US$1,000,000) and GMD 100 million (about US$2,000,000) 2/17/2021 Page 1 of 11 The World Bank Implementation Status & Results Report The Gambia Essential Health Services Strengthening Project (P173287) allocated respectively to RBF and National Health Insurance Scheme (NHIS) for 2021. In the project appraisal document (PAD), the Government Local Fund (GLF) is expected to cover Western Regions 1 and 2 (with 60 percent of The Gambia population) but the estimated GMD 60 million (about US$1,200,000) plus the additional cost for expanding services (i.e., from the limited maternal and child health and nutrition services covered in the previously closed project to include other services in the essential health care package such as integrated management of neonatal and childhood illnesses, infectious diseases, noncommunicable diseases, and emergency obstetric care) far exceeds the GMD 50 million (about US$1,000,000) allocated in the 2021 national budget. The mission advised that the adequacy of GLF to cover RBF for Western Regions 1 and 2 should be monitored closely and shortfalls promptly brought to the attention of MOFEA. The NHIS Bill has been submitted to the National Assembly and is currently with the standing committee on health for review prior to consideration by the full house. Until the NHIS bill is passed, the MOH RBF Unit will continue to serve as the purchaser of health services and will be further strengthened to perform the purchasing role. The project is to support MOH’s efforts to Building Resilient and Sustainable Systems for Health (RSSH) through parallel Co-Financing of Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) allocation of US$5 million, to support designated health systems strengthening thematic areas. This grant is expected to be approved between June and October 2021 after some revisions of the grant proposal as recommended by the GFATM Technical Review Panel (TRP). The materialization of the co-financing arrangement, which was expected to have been in place by December 31, 2020, will be assessed in June 2021. The project is managed and coordinated by the MOH Projects Coordination Unit (PCU). Since September 2020, the PCU has been organizing monthly Project Implementation Committee meetings, chaired by the Permanent Secretary, with the Directors of the implementing MOH directorates. Given the increasing workload, MOH, in consultation with other development partners such as GFATM and Gavi, is finalizing a TOR to recruit additional staff for the PCU. There has been a delay in the recruitment of the External Auditor, but the process is underway. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial -- Moderate Macroeconomic Substantial -- Moderate Sector Strategies and Policies Moderate -- Moderate Technical Design of Project or Program Moderate -- Moderate Institutional Capacity for Implementation and Substantial -- Moderate Sustainability Fiduciary Moderate -- Moderate Environment and Social Moderate -- Moderate Stakeholders Moderate -- Moderate Other -- -- -- Overall Substantial -- Moderate Results PDO Indicators by Objectives / Outcomes Improve quality of essential health services IN00938356 2/17/2021 Page 2 of 11 The World Bank Implementation Status & Results Report The Gambia Essential Health Services Strengthening Project (P173287) ►Health Facility Quality Index (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 69.00 -- 69.00 85.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 The index, on a scale of 0 to 100, is computed for all health centers based on a quality of care Comments: assessment checklist and the average score reported Improve utilization of essential health services IN00938357 ►Essential health services coverage index (Geometric means of tracer indicators, on a scale of 0-100) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.90 -- 45.90 56.38 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Geometric means of six tracer indicators, on a scale of 0-100. The Geometric Mean formula in Excel is Comments: =GEOMEAN(A1:A6) (i.e., geometric mean of the data in cells A1 to A6) IN00938358 Contraceptive prevalence rate (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 17.10 -- 17.10 33.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 IN00938359 Antenatal care, four or more visits (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 78.50 -- 78.50 84.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 IN00938360 Delivery in a health facility (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 83.70 -- 83.70 88.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 IN00938361 Fully immunized children (percentage of children who at age 12-23 months had received all basic vaccinations) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 84.60 -- 84.60 90.00 2/17/2021 Page 3 of 11 The World Bank Implementation Status & Results Report The Gambia Essential Health Services Strengthening Project (P173287) Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 IN00938362 Children aged 6-23 months who received minimum acceptable diet (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 14.00 -- 14.00 19.00 Date 30-Jun-2020 -- 22-Jan-2021 30-Jun-2025 IN00938363 Children under age 5 for whom advice or treatment was sought for symptoms of acute respiratory infection (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 70.30 -- 70.30 77.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Intermediate Results Indicators by Components Component 1: Improving the Delivery and Utilization of Quality Essential Primary Health Care Service IN00938364 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 799,590.00 -- 799,590.00 4,972,800.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 IN00938365 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 399,000.00 -- 399,000.00 2,700,000.00 IN00938366 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 72,412.00 -- 72,412.00 445,000.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 IN00938367 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 668,603.00 -- 668,603.00 4,129,800.00 2/17/2021 Page 4 of 11 The World Bank Implementation Status & Results Report The Gambia Essential Health Services Strengthening Project (P173287) Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 IN00938368 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 58,575.00 -- 58,575.00 398,000.00 Date 30-Jun-2020 -- 22-Jan-2021 30-Jun-2025 IN00938369 ►Pregnant women coming for antenatal care in the first trimester (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 23,216.00 -- 23,216.00 139,000.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Cumulative number of pregnant women who received their first antenatal care in the first trimester IN00938370 ►Delivery by cesarean section (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.70 -- 3.70 7.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Numerator: Number of deliveries by cesarean section *100 Denominator: Number of live births nationally Comments: in the same period IN00938371 ►People enrolled in the NHIS (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 330,000.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Cumulative number of people enrolled in the NHIS (cumulative) IN00938372 ►Timely processing of claims submitted by health facilities to the NHIA (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Numerator: Number of claims submitted by health facilities to the NHIA that were processed in one month Comments: *100 Denominator: Number of claims submitted by health facilities to the NHIA in the same period IN00938373 ►New acceptors of modern contraception (Number, Custom) 2/17/2021 Page 5 of 11 The World Bank Implementation Status & Results Report The Gambia Essential Health Services Strengthening Project (P173287) Baseline Actual (Previous) Actual (Current) End Target Value 80,909.00 -- 80,909.00 280,000.00 Date 30-Jun-2020 -- 22-Jan-2021 30-Jun-2025 Comments: Cumulative number of new acceptors of modern contraception (cumulative) IN00938374 ►Children under 5 treated for moderate or severe acute malnutrition (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2,587.00 -- 2,587.00 9,800.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Cumulative number of children under age 5 years treated for moderate or severe acute malnutrition IN00938375 ►Children age 12-59 months dewormed (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 180,402.00 -- 189,402.00 500,000.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Cumulative number of children age 12-59 months who were dewormed IN00938376 ►Children between the age of 6 and 59 months receiving Vitamin A supplementation (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 234,243.00 -- 234,243.00 1,593,000.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Cumulative number of children between the age of 6 and 59 months receiving Vitamin A supplementation IN00938377 ►Post-partum mothers supplemented with vitamin A (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 55,658.00 -- 55,658.00 333,000.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Cumulative number of post-partum mothers supplemented with vitamin A (cumulative) IN00938378 ►Pregnant women receiving iron and folic acid (IFA) supplements (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 2/17/2021 Page 6 of 11 The World Bank Implementation Status & Results Report The Gambia Essential Health Services Strengthening Project (P173287) Value 286,914.00 -- 286,914.00 1,944,000.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Cumulative number of pregnant women receiving iron and folic acid (IFA) supplements IN00938379 ►Health facilities reporting no stock-out of essential tracer medicines and medical supplies at the time of the health facility quality of care assessment (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 75.00 -- 75.00 90.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Numerator: Number of health facilities reporting no stock-out of essential tracer medicines and medical supplies (magnesium sulphate, amoxicillin, oxytocin, paracetamol, mebendazole, Depo-Provera injection, vitamin A, Sulphadoxine + Pyrimethamine, Tenofovir/Lamivudine/Efavirenz, Comments: Rifampin/isoniazid/pyrazinamide/ethambutol (RHZE), and Ready-to-Use Therapeutic Food (RUTF)) at the time of the health facility quality of care assessment *100 Denominator: Number of health facilities assessed in the same period IN00938380 ►Health facilities that can perform diagnostic services at the time of the health facility quality of care assessment (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.50 -- 10.50 50.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Numerator: Number of health facilities that can perform diagnostic services (12 core tests include: hemoglobin, blood glucose, malaria diagnostic capacity, urine dipstick‐ protein, urine dipstick‐ glucose, HIV diagnostic capacity, Dried Blood Spot collection, TB microscopy, syphilis rapid diagnostic test, Comments: general microscopy, urine pregnancy test, alanine aminotransferase (ALT) test, and creatinine) at the time of the health facility quality of care assessment *100 Denominator: Number of health facilities assessed in the same period IN00938381 ►Quarterly counter verification of health facility service delivery data conducted and report available (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Not available as of July Counter verification Value 31, 2020 for the April- -- Undertaken report available June 2020 quarter Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Quarterly counter verification of health facility service delivery data has been conducted by the MOH M&E Comments: unit and the report is available IN00938382 ►Timely submission of health facilities monthly reports (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 69.80 -- 69.80 90.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Numerator: Number of public health facilities monthly reports submitted by health facilities to the DHIS2 not later than 10th day after the end of each calendar month*100 Denominator: Number of public health 2/17/2021 Page 7 of 11 The World Bank Implementation Status & Results Report The Gambia Essential Health Services Strengthening Project (P173287) facilities in the same period The GFATM equivalent indicator is Timeliness of facility reporting: Percentage of submitted facility monthly reports (for the reporting period) that are received on time per the national guidelines IN00938383 ►Completeness of health facilities monthly reports (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 75.70 -- 75.70 92.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Numerator: Number of public health facilities monthly reports submitted by health facilities to the DHIS2 not later than 30th day after the end of each calendar month*100 Denominator: Number of public health Comments: facilities in the same period The GFATM equivalent indicator is Percentage of expected facility monthly reports (for the reporting period) that are actually received IN00938384 ►Service delivery reports from community health workers integrated into HMIS (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.60 -- 80.60 90.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Numerator: Number of service delivery reports from community health workers integrated into HMIS Comments: during the last quarter of the calendar year Denominator: Number of service delivery reports from community health workers expected during the last quarter of the calendar year. GFATM indicator IN00938385 ►Electronic human resource management information system established (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Web-based electronic No web-based electronic human resource human resource Open source software Value -- management management information identified information system system established Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Web-based electronic human resource management information system established IN00938386 ►Health personnel trained (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 250.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Cumulative number of health personnel trained IN00938387 ►Marriages registered (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 2/17/2021 Page 8 of 11 The World Bank Implementation Status & Results Report The Gambia Essential Health Services Strengthening Project (P173287) Value 5,000.00 -- 5,000.00 40,000.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Cumulative number of marriages registered by the MOH, cumulative IN00938388 ►Births registered (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 101,515.00 -- 101,515.00 783,000.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Cumulative number of births registered by the MOH, cumulative IN00938389 ►Health facilities renovated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 4.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: Renovation of health facilities financed by the project IN00938390 ►National blood transfusion center constructed (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target National blood No national blood Architectural design Value -- transfusion center transfusion center underway constructed Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Comments: National blood transfusion center constructed IN00938391 ►Grievances responded to within stipulated service standards for response (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 30-Jun-2020 -- 22-Jan-2021 29-Aug-2025 Numerator is number of grievances addressed within 7 working days; denominator is number of Comments: grievances reported to MOH Performance-Based Conditions 2/17/2021 Page 9 of 11 The World Bank Implementation Status & Results Report The Gambia Essential Health Services Strengthening Project (P173287) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173287 IDA-D7310 Effective USD 30.00 30.00 0.00 2.00 28.53 6.6% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173287 IDA-D7310 Effective 09-Oct-2020 19-Oct-2020 28-Oct-2020 29-Aug-2025 29-Aug-2025 Cumulative Disbursements PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC 2/17/2021 Page 10 of 11 The World Bank Implementation Status & Results Report The Gambia Essential Health Services Strengthening Project (P173287) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 2/17/2021 Page 11 of 11