The World Bank Report No: ISR273 Implementation Status & Results Peru Public Disclosure Copy PE- (APL2) Health Reform Program (P095563) Operation Name: PE- (APL2) Health Reform Program (P095563) Project Stage: Implementation Seq.No: 4 Status: ARCHIVED Last Modified Date: 10-Feb-2011 Country: Peru Approval FY: 2009 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Adaptable Program Loan Implementing Agency(ies): Ministry of Health - Programa de Apoyo a la Reforma del Sector Salud Key Dates Board Approval Date 17-Feb-2009 Original Closing Date 31-Jan-2015 Planned Mid Term Review Date 31-Aug-2011 Last Archived ISR Date 28-Jun-2010 Effectiveness Date 15-Dec-2009 Revised Closing Date 31-Jan-2015 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) Framed within the long-term objective of the Health Reform Program (APL in all its phases) to reduce maternal and infant mortality rates in the nine poorest regions of the country (Amazonas, Huanuco, Huancavelica, Ayacucho, Apurimac, Cusco, Cajamarca, Ucayali and Puno); the project development objectives are to: (i) improve family care practices for women (during pregnancy, delivery and breast-feeding), and children under the age of three; (ii) strengthen health services networks with capacity to solve obstetric, neonatal and infant emergencies and to provide comprehensive health services to women (during pregnancy, delivery and breast-feeding) and children under the age of three; and (iii) support MINSA's governance functions of regulation, quality, efficiency and equity for improving the new health delivery model of maternal and child health care in a decentralized environment. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Improving health practices at the household level for women and children under age three in rural 6.00 Public Disclosure Copy areas of the nine targeted Regions Increasing the capacity to provide better maternal and child health services for the poor 142.30 Strengthening government capacities to offer more equitable and efficient health system in a 5.20 decentralized environment Project Coordination, and Monitoring & Evaluation 8.90 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Medium-L Page 1 of 6 The World Bank Report No: ISR273 Implementation Status Overview Overall, project implementation can be considered as Satisfactory. All Project Indicators are on track. Furthermore, some indicators, such as institutional births and prenatal care in Public Disclosure Copy rural areas, are above the Project target and will thus reach and surpass the Project's end-line goals in 2011 (three years ahead of schedule). The midterm evaluation that is scheduled for July/August 2011 may therefore discuss the Bank's proposal to increase these and other Project targets. To date, commitment and disbursement rates are low, mostly due to difficulties in the allocation of resources at the Government level. Results Project Development Objective Indicators Indicator Baseline Current End Target Indicator Name Value Value Value Increase the proportion of pregnant women of the nine regions with at 20.00 63.90 45.00 least 1 prenatal control during the first trismester of pregnancy from Date Date Date 20% (2005) to 45% (2013) 30-Dec-2005 19-Nov-2010 30-Dec-2013 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage Percentage has increased substantially. Data for all 2010 is still being collected. However, at this stage, the project has alreadyreached the goal. Indicator Baseline Current End Target Indicator Name Value Value Value Increase the proportion of institutional deliveries in rural areas of the 44.00 59.00 78.00 nine selected Regions from 44% (2005) to 78% (2013) Date Date Date 30-Dec-2005 19-Nov-2010 30-Dec-2013 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage New data collected for 2010 will Public Disclosure Copy reflect important advances. However, using data until September 2010 there is a very positive trend for this indicator. Indicator Baseline Current End Target Indicator Name Value Value Value Reduce the prevalence of anemia among children under age 3 in the 69.50 58.00 60.00 nine regions from 69.5% (2005) to 60% (2013) Date Date Date 30-Dec-2005 19-Nov-2010 30-Dec-2013 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage Data is being collected. Page 2 of 6 The World Bank Report No: ISR273 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Increase from 64% to 80% the share of children in the nine selected 64.00 82.20 80.00 regions who are exclusively breastfed until 6 months of age Date Date Date 30-Dec-2005 19-Nov-2010 30-Dec-2013 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage Second half year data is being collected. However, if the trend is confirmed, the goal has been surpassed. Intermediate Results Indicators Indicator Baseline Current End Target Indicator Name Value Value Value Component 1: % of SIS affiliated children who received growth and 34.00 34.00 66.00 development controls (CRED) according to their age Date Date Date 30-Dec-2005 30-Sep-2010 30-Dec-2013 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage The data of the evaluation about population affiliated to SIS will be finished in 2011 Indicator Baseline Current End Target Indicator Name Value Value Value Component 1: % of children who received growth and development 22.60 28.80 34.00 controls (CRED) according to their age Date Date Date 30-Dec-2007 30-Sep-2010 30-Dec-2013 Public Disclosure Copy Type Unit of Measure Comment Comment Comment Custom Indicator Percentage Indicator Baseline Current End Target Indicator Name Value Value Value Component 2: % of SIS affiliated rural pregnant women with laboratory 37.00 42.00 80.00 tests on hemoglobin, urine and syphilis Date Date Date 30-Dec-2005 10-Jun-2010 30-Dec-2013 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage Page 3 of 6 The World Bank Report No: ISR273 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Component 2: % of pregnant women under SIS that receive iron and 37.00 50.00 80.00 folic acid supplements Date Date Date 30-Dec-2005 19-Nov-2010 30-Dec-2013 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage This indicator has begun to move. The Project is doing important efforts for its improving. In particular, with supplies distribution. Indicator Baseline Current End Target Indicator Name Value Value Value Component 2: % of cesareans in SIS affiliated pregnant rural women 3.00 3.50 5.00 Date Date Date 30-Dec-2005 19-Nov-2010 30-Dec-2013 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage No reports about this indicator, due to difficulties in collecting data. New data is expected for April 2011 Indicator Baseline Current End Target Indicator Name Value Value Value Component 2: % of health facilities with improvement in infrastructure 0.00 0.00 90.00 (minor construction and / new equipment) Date Date Date 30-Dec-2005 19-Nov-2010 30-Dec-2013 Public Disclosure Copy Type Unit of Measure Comment Comment Comment Custom Indicator Percentage Project has initiated infrastructure works in selected health facilities. Procurement process is still delayed. Page 4 of 6 The World Bank Report No: ISR273 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Component 2: % of women satisfied with the services in selected 1.00 1.00 25.00 facilities by confidence index Date Date Date 30-Dec-2005 19-Nov-2010 30-Dec-2013 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage There are delays in implementing a continuous survey of confidence Index Indicator Baseline Current End Target Indicator Name Value Value Value Component 3: % of SIS affiliated households that make out-of-pocket 67.30 67.30 25.00 expenditures in medicines Date Date Date 30-Dec-2005 19-Nov-2010 30-Dec-2013 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage An evaluation of the households that make out-of-pocket expenditures on medicine will be done in 2011. However trend continue to bevery positive Data on Financial Performance (as of 04-Jan-2011) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P095563 IBRD-76430 Effective 17-Feb-2009 16-Nov-2009 15-Dec-2009 31-Jan-2015 Public Disclosure Copy Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P095563 IBRD-76430 Effective USD 15.00 15.00 0.00 0.86 14.14 6.00 Disbursement Graph Page 5 of 6 The World Bank Report No: ISR273 Public Disclosure Copy Key Decisions Regarding Implementation Public information Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Public Disclosure Copy Page 6 of 6