The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) AFRICA EAST | Madagascar | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2018 | Seq No: 7 | ARCHIVED on 01-May-2021 | ISR46345 | Implementing Agencies: Unité de Programme National de Nutrition Communautaire (UPNNC), REPUBLIC OF MADAGASCAR, Unité de Coordination des Projets (UCP) - Ministry of Public Health Key Dates Key Project Dates Bank Approval Date: 12-Dec-2017 Effectiveness Date: 13-Apr-2018 Planned Mid Term Review Date: 07-Dec-2020 Actual Mid-Term Review Date: 11-Jan-2021 Original Closing Date: 31-Jul-2023 Revised Closing Date: 31-Jul-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase utilization of an evidence-based package of reproductive, maternal and child health and nutrition (RMCHN) interventions and improve key nutrition behaviors known to reduce stunting in targeted regions and to provide immediate and effective response to an eligible crisis or emergency. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Scale up coverage and utilization of the RMCHN minimum package:(Cost $54.00 M) Strengthen capacity to manage and deliver the RMCHN minimum package:(Cost $29.50 M) Project Management, Capacity Building and Operations Support:(Cost $6.50 M) Contingent Emergency Response Component (CERC):(Cost $20.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Moderate Implementation Status and Key Decisions The Mid-Term Review (MTR) mission took place from January 11-22, 2021. Progress towards achieving the project's development objectives indicators is mixed while progress toward intermediate outcomes is generally on track. The program has supported the rapid expansion of services through 3,176 community sites strengthened with health and nutrition commodities and equipment, 510 basic health centers strengthened with nutrition and health commodities and equipment, and 144 non-government organizations strengthened and supported in their community site support and mentoring technical activities. As a result, the project has enabled more than 1 million women and children under 5 to benefit from a package of health and nutrition services at the community platform. The project is focusing on improving the quality of integrated health and nutrition 5/1/2021 Page 1 of 9 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) service implementation. The project team and the World Bank team agreed to continue regular meetings to monitor and facilitate project implementation. It was also agreed to restructure the project to reallocate funds between disbursement categories and revise the results framework. Project performance during 2021 will be critical to accelerate the preparation of the second phase of the multi-phase programmatic approach. MPA Program Development Objective MPA PDO Table The Program Development Objective (PrDO) is to reduce stunting prevalence in children under 2 years of age in targeted regions. MPA Table Multiphase Programmatic Approach (MPA) Status MPA Table Body The MPA nutrition program of up to US$200 million has three phases that will be implemented over 10 years. These phases will overlap and each phase will incorporate lessons and experiences from previous phases. The first phase, in the amount of US$90 million become effective in April 2018 and is implemented in the eight regions with high rates of chronic malnutrition (51% across all 8 regions, MICS 2018), targeting nearly 2 million children under 5, pregnant and lactating women. The COVID-19 pandemic has introduced implementation challenges as a result of various levels of lockdown or mobility restrictions and virtual implementation support missions with World Bank teams. Notwithstanding challenges, the MPA is on track to achieving its PDO of the first phase - increase utilization of an evidence-based package of reproductive, maternal and child health and nutrition (RMCHN) interventions and improve key nutrition behaviors known to reduce stunting in targeted regions. The significant level of disbursements at the mid-term of the first phase (64%) attest to the strong implementation thanks to the commitment of country teams. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Moderate Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Moderate Institutional Capacity for Implementation and High High Moderate Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Low Moderate Low Stakeholders Low Low Low Other Low Low Low Overall Substantial Substantial Moderate Results 5/1/2021 Page 2 of 9 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) PDO Indicators by Objectives / Outcomes Improve key nutrition behaviors known to reduce stunting in targeted regions IN00982006 ►Percentage of infants 0-5 months of age exclusively breastfed (by sex) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 61.30 61.30 64.60 65.00 Date 01-Jul-2018 30-Sep-2020 16-Apr-2021 31-Jul-2023 SMART survey data - December 2020 Comments: IN00982008 ►Percentage of women receiving any IFA tablets at last pregnancy (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 59.00 35.80 70.00 Date 11-Sep-2017 30-Sep-2020 16-Apr-2021 31-Jul-2023 SMART survey data from December 2020. With the current COVID-19 situation, the distribution of IFA Comments: tablets was sometimes interrupted due to stock shortages at the SALAMA Purchasing Center IN00982009 ►Percentage of children 6-23 months of age receiving 5 of the 8 recommended food groups (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 31.50 3.90 19.30 36.50 Date 11-Sep-2017 30-Sep-2020 16-Apr-2021 31-Jul-2023 We have the current situation with the SMART survey in December 2020. The impact of the health situation due to COVID-19 has increased household food insecurity, making it impossible for households Comments: to provide adequate nutrition for their children Increase utilization of package of RMCHN interventions known to reduce stunting in targeted regions IN00981935 ►Percentage of children 6-59 months of age receiving vitamin A supplementation within the past 6 months (by sex) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 49.50 63.20 60.00 Date 11-Sep-2017 30-Sep-2020 16-Apr-2021 31-Jul-2023 The MICS 2018 data as a baseline does not provide value for this indicator. The current Data was from Comments: SMART survey data December 2020 IN00982007 5/1/2021 Page 3 of 9 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) ►Number of facility-based deliveries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 138,480.00 193,765.00 588,623.00 Date 11-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 Value as of end February 2021 Comments: Intermediate Results Indicators by Components Strengthen capacity to manage and deliver the RMCHN minimum package IN00982011 ►Number of community health and nutrition workers trained by the project on at least 2 modules (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6,160.00 7,196.00 10,100.00 Date 11-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 Value as of end February 2021 Comments: IN00982014 ►Percentage of community health and nutrition workers achieving satisfactory score on the community service delivery indicator (SDI) score (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 11-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 No changes in the indicator were expected in this reporting period. Data will be updated when the SDI Comments: 2020 report is available. IN00982017 ►Percentage of providers at the primary care facilities achieving satisfactory score on the service delivery indicator (SDI) score (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.90 1.90 1.90 50.00 Date 11-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 No changes in the indicator were expected in this reporting period. Data will be updated when the SDI Comments: 2020 report is available. IN00982021 ►Percentage of primary care facilities providing monthly activity reports on time (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 5/1/2021 Page 4 of 9 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) Value 34.00 94.10 60.00 80.00 Date 11-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 2020 target surpassed at 175%. This positive improvement is obtained thanks to the effectiveness of contractualization activities with health workers and the BPF approach. Current Value as of end February Comments: 2021. IN00982023 ►Percentage of communes that organized at least 1 CoSan meeting in the past 6 months (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 11-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 No result reported due to COVID-19 restriction on meeting and gathering. Comments: Scale up coverage and utilization of the RMCHN minimum package IN00982010 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 873,421.00 1,098,592.00 2,871,000.00 Date 19-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 Value as of end February 2021 Comments: IN00982016 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 239,667.00 360,673.00 171,000.00 Date 19-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 IN00982019 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 633,754.00 737,919.00 2,700,000.00 Date 19-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 IN00982020 ►Number of women receiving ANC during the first 3 months of pregnancy (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 137,719.00 90,385.00 294,607.00 5/1/2021 Page 5 of 9 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) Date 11-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 The baseline value has been revised to 0, the current value as of end February 2021 has taken this Comments: change into account IN00982022 ►Number of functioning community sites (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,936.00 3,176.00 5,050.00 Date 11-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 Value as of end February 2021 Comments: IN00982024 ►Number of severe acute malnutrition (SAM) cases treated in the outpatient SAM treatment program (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 870.00 15,217.00 24,487.00 8,000.00 Date 21-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 Value as of end February 2021. End year target achieved at 378% due to effective diagnostic and referral Comments: from community sites, and the voucher system. The project target will be revised. IN00982025 ►Number of primary care facilities having tracer medications in stock (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 296.00 326.00 776.00 700.00 Date 11-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 Value as of end February 2021. Comments: Project Management, Capacity Building and Operations Support IN00982012 ►Grievances responded to and/or resolved within the stipulated service standard for response times (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 79.00 80.00 75.00 Date 21-Sep-2017 31-Aug-2020 16-Apr-2021 31-Jul-2023 Value as end of February 2021. Training for project actors has been completed at all levels. Comments: CERC IN00982013 5/1/2021 Page 6 of 9 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) ►Number of health workers in public primary health care facilities trained in Integrated Disease Surveillance and Response (IDSR) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 634.00 634.00 3,772.00 Date 01-Apr-2020 31-Aug-2020 16-Apr-2021 31-Jul-2023 2020 target achieved at 22%. The objective is overestimated by ensuring national coverage when this activity will be and is already being achieved through the contribution of all MOH partners. As of February Comments: 2021, there is no change. No training has been conducted to date. IN00982015 ►Number of designated laboratories with COVID-19 diagnostic capacity (equipment, test kits, reagents) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 17.00 17.00 17.00 Date 01-Apr-2020 31-Aug-2020 16-Apr-2021 31-Jul-2023 The project goal was reached in 2020. Comments: IN00982018 ►Number of health facilities with no stock-outs of PPE during the last 30 days (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,667.00 2,667.00 1,280.00 Date 01-Apr-2020 31-Aug-2020 16-Apr-2021 31-Jul-2023 The value of the indicator remains the same. This indicator will no longer be tracked, and will be changed. Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P160848 IDA-67020 Effective USD 10.00 10.00 0.00 0.00 10.62 0% P160848 IDA-D2570 Effective USD 80.00 80.00 0.00 66.79 12.64 84% P160848 IDA-D6740 Effective USD 10.00 10.00 0.00 0.00 10.62 0% P160848 TF-A6102 Effective USD 10.00 10.00 0.00 5.81 4.19 58% P160848 TF-B3952 Closed USD 1.76 1.76 0.00 1.74 0.02 99% 5/1/2021 Page 7 of 9 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P160848 IDA-67020 Effective 08-Jun-2020 24-Jun-2020 01-Mar-2021 31-Jul-2023 31-Jul-2023 P160848 IDA-D2570 Effective 12-Dec-2017 14-Dec-2017 13-Apr-2018 31-Jul-2023 31-Jul-2023 P160848 IDA-D6740 Effective 08-Jun-2020 24-Jun-2020 01-Mar-2021 31-Jul-2023 31-Jul-2023 P160848 TF-A6102 Effective 12-Dec-2017 14-Dec-2017 13-Apr-2018 31-Jul-2023 31-Jul-2023 P160848 TF-B3952 Closed 17-Oct-2020 03-Nov-2020 30-Nov-2020 31-Jan-2021 31-Jan-2021 Cumulative Disbursements PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History There has been no restructuring to date. Related Project(s) 5/1/2021 Page 8 of 9 The World Bank Implementation Status & Results Report Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) P173950-Additional Financing to Improving Nutrition Outcomes Project Using the Multiphase Programmatic Approach ,P174669-Second Additional Financing for the Improving Nutrition Outcomes Project Using the Multiphase Programmatic Approach 5/1/2021 Page 9 of 9