The World Bank Report No: ISR14527 Implementation Status & Results Bolivia Expanding Access to Reduce Health Inequities Project (APL III)--Former Health Sector Reform - Third Phase (APL III) (P101206) Public Disclosure Copy Operation Name: Expanding Access to Reduce Health Inequities Project (APL Project Stage: Implementation Seq.No: 14 Status: ARCHIVED Archive Date: 31-May-2014 III)--Former Health Sector Reform - Third Phase (APL III) (P101206) Country: Bolivia Approval FY: 2008 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Adaptable Program Loan Implementing Agency(ies): Ministry of Health, Social Investment and Productive Fund (SPF) Key Dates Board Approval Date 24-Jan-2008 Original Closing Date 31-Jan-2014 Planned Mid Term Review Date 30-Nov-2011 Last Archived ISR Date 20-Oct-2013 Effectiveness Date 19-Jun-2009 Revised Closing Date 31-Jul-2014 Actual Mid Term Review Date 19-Aug-2013 Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objectives for APL III are the same as those of the previous two phases: increasing access to good quality and culturally appropriate health services to improve the health of the population in general and to mothers and children in particular. As a medium-term objective, the APL series pursues reducing the infant and maternal mortality rates by one-third, as per the proposed indicators for the Program. Under APLs I and II an important set of policies and interventions were developed to strengthen the performance of the public health services. These policies and interventions aimed to improve child and maternal health status, including expansion of the insurance system (the Universal maternal and child insurance, SUMI, at present), the investments in primary health care, and the strengthening of cost-effective health interventions (PAI, IMCI). APL I introduced a basic health insurance (the Seguro B?sico de Salud, today SUMI) to reinforce provisions to mothers and children, and a new vaccination system and set of new management tools. APL II is implementing an expanded version of maternal and child insurance, by supporting the deployment of mobile health brigades (EXTENSA) as a way of expanding service delivery to underserved areas, and new management tools (performance agreements, and demand-driven investment policy) are being used. The Government has provided sustainability to health insurance as well as to the EXTENSA program that is now being absorbed by the regional and/or municipal budgets. The EXTENSA Unit in the MOH that was part of the APL II PIU is being incorporated in the structure of the MOH. All regions benefited with support from investments, mainly in primary care. The proposed APL III aims to sustain the trend in improving the IMR and accelerate the reduction of the MMR, which a recent modeling exercise shows to be a challenge. APL III would consolidate the strategies implemented under APLs I and II by: i) strengthening the regulatory capacity of national, regional and local levels to Public Disclosure Copy perform critical EFPH; ii) promoting the demand of maternal and infant health services through developing and enhancing the culturally appropriate maternal and infant health referral network; and iii) supporting implementation of the new expansion of the insurance system (Universal Health Insurance - SUSALUD. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Page 1 of 7 The World Bank Report No: ISR14527 Component(s) Component Name Component Cost Stewardship Role of Health Authorities - Essential Functions in Public Health 2.34 Public Disclosure Copy Family, Community and Intercultural Health 7.29 Health Insurance Program 3.20 Project Administration 0.90 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Moderate Implementation Status Overview The Project was approved by the Board on January 24, 2008. It was signed on September 19, 2008 and declared effective on June 19, 2009. The current disbursed amount is XDR 3.8 million (approximately 56% of the total revised credit amount). By May 2014, the following Project Development targets (PDIs) have been achieved: a) The ratio between the percentage of pregnant women receiving four pre-natal care in the areas of project intervention and the rest of the country increased from 0.66 to 0.94 surpassing the target of 0.85; and b) the ratio between the percentage of institutional deliveries in the areas of project intervention and the rest of the country increased from 0.68 to 0.89 surpassing the target of 0.85; and two intermediate indicators have been achieved: a) the SNIS has completed and includes the new information modules; and b) the percentage of municipalities achieving 80% of the management performance tracers at the national level is 55% surpassing the target of 40%. Locations Country First Administrative Division Location Planned Actual Bolivia Departamento de La Paz Yaco ✔ Bolivia Departamento de La Paz Waldo Ballivian ✔ Bolivia Departamento de Cochabamba Villa Viscarra ✔ Public Disclosure Copy Bolivia Departamento de La Paz Villa General Perez ✔ Bolivia Departamento de La Paz Sicasica ✔ Bolivia Departamento de La Paz Umala ✔ Bolivia Oruro Turco ✔ Bolivia Oruro Toledo ✔ Bolivia Departamento de Cochabamba Sicaya ✔ Page 2 of 7 The World Bank Report No: ISR14527 Country First Administrative Division Location Planned Actual Bolivia Departamento de La Paz Sapahaqui ✔ Public Disclosure Copy Bolivia Departamento de Cochabamba Santivanez ✔ Bolivia Departamento del Beni Santa Ana de Yacuma ✔ Bolivia Departamento de La Paz San Pedro ✔ Bolivia Departamento de La Paz Pelechuco ✔ Bolivia Departamento de La Paz Patacamaya ✔ Bolivia Departamento de Cochabamba Pasorapa ✔ Bolivia Departamento de La Paz Papel Pampa ✔ Bolivia Departamento de Cochabamba Omereque ✔ Bolivia Departamento de Cochabamba Morochata ✔ Bolivia Departamento de Cochabamba Mizque ✔ Bolivia Departamento de La Paz Malla ✔ Bolivia Departamento de La Paz Luribay ✔ Bolivia Departamento de Cochabamba Independencia ✔ Bolivia Oruro Exaltacion ✔ Bolivia La Paz Estancia Toco Vilaque ✔ Bolivia Oruro El Choro ✔ Bolivia Departamento de La Paz El Alto ✔ Public Disclosure Copy Bolivia Departamento de La Paz Curva ✔ Bolivia Oruro Corque ✔ Bolivia Departamento de La Paz Colquencha ✔ Bolivia Departamento de La Paz Collana ✔ Bolivia Departamento de Cochabamba Cochabamba ✔ Bolivia Departamento de La Paz Chuma ✔ Bolivia Departamento de La Paz Chacarilla ✔ Page 3 of 7 The World Bank Report No: ISR14527 Bolivia Departamento de Cochabamba Capinota ✔ Bolivia Departamento de La Paz Callapa ✔ Public Disclosure Copy Bolivia Departamento de La Paz Calamarca ✔ Bolivia Departamento de La Paz Cairoma ✔ Bolivia Departamento de Cochabamba Bolivar ✔ Bolivia Oruro Belen de Anamarca ✔ Bolivia Departamento de La Paz Ayo Ayo ✔ Bolivia Departamento de La Paz Ayata ✔ Bolivia Departamento de La Paz Aucapata ✔ Bolivia Departamento de Cochabamba Arque ✔ Bolivia Departamento de La Paz Apolo ✔ Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Ratio between the percentage of pregnant Text Value 0.66 0.94 0.85 women receiving four pre-natal care in the Date 13-Dec-2007 01-Nov-2013 31-Jul-2014 areas of project intervention and the rest of the Comments End of Project target was Target under revision country achieved in 2012. Ratio between the percentage of institutional Text Value 0.68 0.89 0.85 deliveries in the areas of project intervention Date 13-Dec-2007 01-Nov-2013 31-Jul-2014 and the rest of the country Comments End of Project target was Public Disclosure Copy achieved in 2012. Percentage of 2 year old children with a height Text Value 37.60 32.10 22.0 over # 2Z scores in the intervention areas of Date 13-Dec-2007 31-Dec-2012 31-Jul-2014 the project Comments Percentage of children receiving exclusive Text Value 51 65.0 breast feeding at 6 months in the project areas Date 31-Dec-2008 31-Jan-2012 31-Jul-2014 Comments This indicator has not been measured. Page 4 of 7 The World Bank Report No: ISR14527 Porcentage of Target Population Enrolled in Percentage Value 0.00 0.00 80.00 Project Areas Date 31-Dec-2008 31-Dec-2012 31-Jul-2014 Comments This indicator cannot be Public Disclosure Copy followed up because the Universal Health Insurance (SUSALUD) was not established Health Insurance Management Module Reports Percentage Value 0.00 0.00 80.00 Include Information About Production Date 31-Dec-2008 31-Mar-2014 31-Jul-2014 Comments This indicator cannot be followed up because the Universal Health Insurance (SUSALUD) was not established Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target The SNIS include the new information modules Text Value 0 100.00 100.00 Date 13-Dec-2007 31-Mar-2013 31-Jul-2014 Comments End of Project target was achieved in 2013. The modules included in the SNIS are fully Percentage Value 0.00 60.00 100.00 implemented in the 9 SEDES, the 9 Date 31-Dec-2008 31-Mar-2014 31-Jul-2014 Departments and all the heads of the referral Comments networksin the intervention areas The health units apply the sector regulations Percentage Value 0.00 20.00 80.00 norms and the PRONAC norms Date 31-Dec-2008 31-Mar-2014 31-Jul-2014 Comments Monitoring and Evaluation of the Project done Percentage Value 0.00 50.00 80.00 Public Disclosure Copy with regular reports from the information Date 31-Mar-2014 31-Jul-2014 system providing the data (reports should have Comments Indicator will be revised. the data disaggregated) Percentage of Referral Networks evaluated as Percentage Value 0.00 0.00 80.00 satisfactory in the yearly quality assessment Date 31-Dec-2008 31-Mar-2014 31-Jul-2014 Comments This indicator has not been measured Page 5 of 7 The World Bank Report No: ISR14527 Percentage of pregnant women receiving pre- Percentage Value 55.00 47.00 60.00 natal care within the first 20 weeks of Date 31-Dec-2008 31-Mar-2014 31-Jul-2014 pregnancy in the areas of intervention. Comments This indicator has not been Public Disclosure Copy measured Percentage of mothers receiving post-natal Percentage Value 0.00 0.00 80.00 care within 7 days of delivery in the areas of Date 31-Dec-2008 31-Mar-2014 31-Dec-2014 intervention Comments This indicator has not been measured Percentage of children under 2 years old who Percentage Value 66.00 32.00 80.00 participate in the growing monitoring sessions Date 31-Dec-2008 31-Dec-2011 in the areas of intervention Comments Percentage of indigenous people satisfied with Percentage Value 0.00 0.00 60.00 the delivery of services received Date 31-Dec-2008 31-Mar-2014 31-Jul-2014 Comments This indicator has not been measured Porcentage of target population enrolled at Percentage Value 0.00 0.00 80.00 SUSALUD at national level Date 31-Dec-2008 31-Mar-2014 31-Jul-2014 Comments SUSALUD has not been implemented. Percentage of municipalities achieving 80% of Percentage Value 0.00 55.00 40.00 the managment performance tracers at the Date 30-Apr-2008 31-Dec-2012 31-Dec-2014 national level Comments End of Project target was achieved in 2012. Percentage of population receiving services Percentage Value 0.00 0.00 40.00 satisfied ith the quality of the services Date 31-Dec-2008 31-Mar-2014 31-Jul-2014 Comments This indicator has not been measured Public Disclosure Copy Data on Financial Performance (as of 05-May-2014) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P101206 IDA-43820 Effective 24-Jan-2008 19-Sep-2008 19-Jun-2009 31-Jan-2014 31-Jul-2014 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P101206 IDA-43820 Effective XDR 11.70 6.85 4.85 4.05 2.80 59.00 Page 6 of 7 The World Bank Report No: ISR14527 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation Project restructuring is underway. Restructuring History Level two Approved on 12-Dec-2012, Level 2 CD Decision on 10-Jan-2014 Related Projects There are no related projects. Public Disclosure Copy Page 7 of 7