The World Bank Implementation Status & Results Report NI - INTEGRATED PUBLIC PROVISION OF HEALTH CARE SERVICES (P164452) NI - INTEGRATED PUBLIC PROVISION OF HEALTH CARE SERVICES (P164452) LATIN AMERICA AND CARIBBEAN | Nicaragua | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2018 | Seq No: 6 | ARCHIVED on 26-Jan-2021 | ISR43239 | Implementing Agencies: Ministry of Health - Nicaragua, Republic of Nicaragua Key Dates Key Project Dates Bank Approval Date: 15-Mar-2018 Effectiveness Date: 29-Jun-2018 Planned Mid Term Review Date: 06-May-2020 Actual Mid-Term Review Date: 08-Jun-2020 Original Closing Date: 30-Aug-2023 Revised Closing Date: 30-Aug-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The objective of the Project is to extend the coverage and improve the quality of care for the most prevalent health conditions with an emphasis on vulnerable groups. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Results based financing for quality improvement in prevention and provision of health care services to the poorest 66 municipalities:(Cost $14.00 M) Support to the implementation of National Health Strategies for the provision of quality health services under the MOSAFC:(Cost $44.50 M) Provision of contingency financing in the case of a Public Health Alert, or a Public Health Emergency Project management:(Cost $1.50 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Moderate Implementation Status and Key Decisions The Project was approved on March 15, 2018 and the credit was signed on April 2, 2018. Project implementation is progressing well and the mid- term review took place in May/June 2020. The Project is on track to achieve its development objectives of extending the coverage and improving the quality of care for the most prevalent health conditions with an emphasis on vulnerable groups. 1/26/2021 Page 1 of 8 The World Bank Implementation Status & Results Report NI - INTEGRATED PUBLIC PROVISION OF HEALTH CARE SERVICES (P164452) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Substantial Substantial Macroeconomic Moderate Substantial Moderate Sector Strategies and Policies Low Low Low Technical Design of Project or Program Low Low Low Institutional Capacity for Implementation and Low Moderate Moderate Sustainability Fiduciary Moderate Moderate Moderate Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other -- Substantial Substantial Overall Moderate Substantial Moderate Results PDO Indicators by Objectives / Outcomes Extend the coverage and improve the quality of care for the most prevalent health conditions IN00885695 ►Percentage of adolescents (<20 years of age) with institutional birth delivery – G1 (Coverage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 44.00 44.00 94.90 50.00 Date 30-Dec-2016 30-Dec-2016 30-Dec-2019 30-Dec-2022 This indicator improved significantly and surpassed the end of project targets. This improvement is linked to the Government's opening of maternal houses targeting pregnant adolescents. Comments: Numerator = Number of institutional birth delivery among adolescents Denominator= Number of birth deliveries among adolescents IN00885707 Percentage of adolescents (<20 years of age) with institutional birth delivery -G2 (Coverage) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 76.00 76.00 99.20 82.00 Date 30-Dec-2016 30-Dec-2016 30-Dec-2019 30-Dec-2022 1/26/2021 Page 2 of 8 The World Bank Implementation Status & Results Report NI - INTEGRATED PUBLIC PROVISION OF HEALTH CARE SERVICES (P164452) IN00885709 Percentage of adolescents (<20 years of age) with institutional birth delivery – G3 (Coverage) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 80.00 98.40 88.00 Date 30-Dec-2016 30-Dec-2016 30-Dec-2019 30-Dec-2022 Improve the quality of care for the most prevalent health conditions IN00885706 ►Percentage of health centers certified on screening of hypertension – G1 (Quality) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 34.00 89.00 89.00 53.00 Date 30-Dec-2016 31-Dec-2019 31-Dec-2019 30-Dec-2022 IN00885708 Percentage of health centers certified on screening of hypertension – G2 (Quality) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 81.00 81.00 69.00 Date 30-Dec-2016 31-Dec-2019 31-Dec-2019 30-Dec-2022 IN00885710 Percentage of health centers certified on screening of hypertension – G3 (Quality) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 92.00 92.00 80.00 Date 30-Dec-2016 31-Dec-2019 31-Dec-2019 30-Dec-2022 Overall Comments PDO This indicator surpassed the end of Project target. Intermediate Results Indicators by Components C1: RBFfor quality improvement in prevention and provision of health care services in poorest 66 mun IN00885711 ►Percentage of women receiving prenatal care coverage G1 (at least four visits) (Coverage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 54.00 55.00 77.00 58.00 1/26/2021 Page 3 of 8 The World Bank Implementation Status & Results Report NI - INTEGRATED PUBLIC PROVISION OF HEALTH CARE SERVICES (P164452) Date 30-Dec-2016 31-Dec-2018 30-Dec-2019 30-Dec-2022 The municipalities are classified into three groups: (a) those monitoring to improve quality and access (G1); (b) those monitoring to improve quality (G2); and (c) those monitoring for sustainability of the Comments: introduced quality control measures (G3). The effort of MINSA would be to maintain these indicators during 2020 . IN00885714 Percentage of women receiving prenatal care coverage G2 (at least four visits) (Coverage) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 67.00 73.00 81.00 72.00 Date 30-Dec-2016 31-Dec-2018 30-Dec-2019 30-Dec-2022 IN00885716 Percentage of women receiving prenatal care coverage G3 (at least four visits) (Coverage) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 71.00 88.00 96.00 78.00 Date 30-Dec-2016 31-Dec-2018 30-Dec-2019 30-Dec-2022 IN00885717 ►Citizen Council participation in the Project Verification Commission for the implementation of the Quality of Health Care Plan (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 3.00 Date 29-Dec-2017 31-Dec-2019 31-Dec-2019 28-Jul-2023 IN00885719 ►Percentage of children under 1 year of age receiving three doses of pentavalent vaccine G1 (Coverage; Quality: safety) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 86.00 100.00 100.00 89.00 Date 31-Oct-2017 31-Dec-2019 31-Dec-2019 30-Dec-2022 IN00885721 ►Percentage of children under 1 year of age receiving three doses of pentavalent vaccine G2 (Coverage; Quality: safety) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 95.00 100.00 100.00 95.00 Date 31-Oct-2017 31-Dec-2019 31-Dec-2019 30-Dec-2022 IN00885723 ►Percentage of children under 1 year of age receiving three doses of pentavalent vaccine G3 (Coverage; Quality: safety) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 97.00 100.00 100.00 97.00 1/26/2021 Page 4 of 8 The World Bank Implementation Status & Results Report NI - INTEGRATED PUBLIC PROVISION OF HEALTH CARE SERVICES (P164452) Date 31-Oct-2017 31-Dec-2019 31-Dec-2019 30-Dec-2022 IN00885725 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 870,231.00 870,231.00 0.00 Date 28-Dec-2018 31-Dec-2019 31-Dec-2019 29-Dec-2023 The end of target population will be added once the Project completes implementation as per definition of the corporate indicator. Presented data needs to be cumulative. T The indicator measures the sum of the number of children immunized, the number of women and children who have received basic nutrition services, and the number of deliveries attended by skilled health personnel, through operations supported by the World Bank. Details Comments: The baseline value for this indicator is zero. (A “zero” in the baseline means that a newly approved project has not started contributing to the provision of essential HNP services.) Subsequently, the data should be cumulative—that is, the data in the ISR should represent the cumulative number of people who have received essential HNP services through a Bank financed project. The cumulative value of year x is equal to the cumulative value of previous year x-1 plus the value for year x; that is, for the cumulative Year 1 the value for Year 1 is reported, and for the cumulative Year 2, Year 1 + Year 2 is reported. IN00885727 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 870,231.00 870,231.00 0.00 Date 28-Dec-2018 31-Dec-2019 31-Dec-2019 29-Dec-2023 C2: Support to the implemen. of national health strategies for the provision of quality health serv IN00885712 ►Entomology areas fully equipped and providing services (Quality: timeliness) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 10.00 10.00 13.00 Date 30-Oct-2017 31-Dec-2019 31-Dec-2019 30-Dec-2022 IN00885713 ►Number of health facilities with updated and implemented waste management plans (Quality: safety, efficiency) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 27.00 45.00 57.00 63.00 Date 30-Dec-2016 31-Dec-2019 11-Dec-2020 30-Dec-2022 IN00885715 ►National Laboratory for the assessment of residual waters refurbished (Quality: safety, efficiency, effectiveness) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 1/26/2021 Page 5 of 8 The World Bank Implementation Status & Results Report NI - INTEGRATED PUBLIC PROVISION OF HEALTH CARE SERVICES (P164452) Value 0.00 1.00 1.00 1.00 Date 30-Oct-2017 31-Dec-2019 31-Dec-2019 30-Dec-2022 IN00885718 ►Percentage increase of women between 30-49 years of age with screening for cervical cancer G1 (Quality: timeliness) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 1.00 Date 31-Oct-2017 28-Dec-2018 28-Dec-2019 30-Dec-2022 Baseline was collected in 2018 and includes the total number of women ages 30 to 49 years old who had cervical cancer screening. This is the first time the country is collecting this information. Comments: The baseline is constructed based on 2018 data of 656,500 women tested for cervical cancer. IN00885720 Percentage increase of women between 30-49 years of age with screening for cervical cancer G2 (Quality: timeliness) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 2.00 Date 31-Oct-2017 28-Dec-2018 28-Dec-2019 30-Dec-2022 IN00885722 Percentage increase of women between 30-49 years of age with screening for cervical cancer G3 (Quality: timeliness) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 3.00 Date 31-Oct-2017 28-Dec-2018 28-Dec-2019 30-Dec-2022 IN00885724 ►Number of health personnel receiving training (Quality: effectiveness ) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5,286.00 5,286.00 1,000.00 Date 30-Oct-2017 31-Dec-2019 31-Dec-2019 30-Dec-2022 This indicator measures the cumulative number of health personnel receiving training through a Bank- financed project. Comments: End of Project target surpassed. IN00885726 ►Number of municipal health units implementing traditional medicine (Quality: patient-centered, equity) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 12.00 186.00 186.00 48.00 Date 31-Oct-2017 31-Dec-2019 31-Dec-2019 30-Dec-2022 1/26/2021 Page 6 of 8 The World Bank Implementation Status & Results Report NI - INTEGRATED PUBLIC PROVISION OF HEALTH CARE SERVICES (P164452) The baseline corresponds to the target in Project P152136. 12 units of traditional medicine estimated based on the number of SILAIS with the presence of the indigenous population. However, MINSA requested support to expand the units to the 153 municipalities. In addition, two units were established in Comments: bigger municipalities following the country's guidance that acknowledged the importance of these units for the population. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P164452 IDA-61990 Effective USD 60.00 60.00 0.00 20.68 39.32 34% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P164452 IDA-61990 Effective 15-Mar-2018 02-Apr-2018 29-Jun-2018 30-Aug-2023 30-Aug-2023 Cumulative Disbursements 1/26/2021 Page 7 of 8 The World Bank Implementation Status & Results Report NI - INTEGRATED PUBLIC PROVISION OF HEALTH CARE SERVICES (P164452) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History Level 2 Approved on 25-Nov-2019 Related Project(s) P174463-AF to the Integrated Public Provision of Health Care Services - COVID-19 1/26/2021 Page 8 of 8