The World Bank Report No: ISR1332 Implementation Status & Results Bolivia Public Disclosure Copy Expanding Access to Reduce Health Inequities Project (APL III)--Former Health Sector Reform - Third Phase (APL III) (P101206) Operation Name: Expanding Access to Reduce Health Inequities Project (APL Project Stage: Implementation Seq.No: 9 Status: ARCHIVED Last Modified Date: 09-Feb-2011 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 07-Nov-2011 Last Archived ISR Date 30-Jun-2010 Effectiveness Date 19-Jun-2009 Revised Closing Date 31-Jan-2014 Actual Mid Term Review Date 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. Public Disclosure Copy 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 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 6 The World Bank Report No: ISR1332 Component(s) Component Name Component Cost Public Disclosure Copy Stewardship Role of Health Authorities - Essential Functions in Public Health 4.00 Family, Community and Intercultural Health 9.90 Health Insurance Program 3.20 Project Administration 0.90 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Unsatisfactory Overall Risk Rating Implementation Status Overview The Project has two years and half of effectiveness. Project implementation began with delay and most of the first year of regular execution (2010) has been used for organizing the support to MoH units as defined in the institutional arrangements. The project'sOperation Plan was approved in 2010 after many delays due to lack of definitions and MoH's internal constant turnover. Component one is moving along in the adjustments for the implementation of the SNIS system where a module on Human Resources should be included. The project has made progress in the implementation of Component two, preparing a "rapid" assessment of the infrastructure and equipment in the prioritized health care centers. The project (MoH) would support two specialized professionals to review appropriateness and functionality before remodeling designs of the health facilities become funded through the SPF. Two health networks, La Paz and Santa Cruz, (within the 89 selected municipalities project's target) have been approved for the remodeling/extension projects at the design stage. Component three is supporting the discussion of the Unified Health System in the Departmental assembles in Potosí, Beni, Pando, La Paz, Potosí y Cochabamba and the pilot integration between Insurance Units and SNIS information systems. Component four is supporting the discussion of the Ministry of Health Stewardship capabilities. Results Project Development Objective Indicators Public Disclosure Copy Indicator Baseline Current End Target Indicator Name Value Value Value Ratio between the percentage of pregnant women receiving four pre- 0.66 - 0.85 natal care in the areas of project intervention and the rest of the country Date Date Date 13-Dec-2007 17-Jun-2010 31-Jan-2014 Type Unit of Measure Comment Comment Comment Custom Indicator Text Page 2 of 6 The World Bank Report No: ISR1332 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Ratio between the percentage of institutional deliveries in the areas of 0.68 - 0.85 project intervention and the rest of the country Date Date Date 13-Dec-2007 17-Jun-2010 31-Jan-2014 Type Unit of Measure Comment Comment Comment Custom Indicator Text Indicator Baseline Current End Target Indicator Name Value Value Value Percentage of 2 year old children with a height over # 2Z scores in the 37.6 - 22 intervention areas of the projec Date Date Date 13-Dec-2007 17-Jun-2010 31-Jan-2014 Type Unit of Measure Comment Comment Comment Custom Indicator Text Indicator Baseline Current End Target Indicator Name Value Value Value Percentage of children receiving exclusive breast feeding at 6 months 51 - 65 in the project areas Date Date Date 13-Dec-2007 17-Jun-2010 31-Jan-2014 Type Unit of Measure Comment Comment Comment Custom Indicator Text Indicator Baseline Current End Target Indicator Name Value Value Value Percentage of target population enrolled in the project area 0 - 80 Public Disclosure Copy Date Date Date 13-Dec-2007 17-Jun-2010 31-Jan-2014 Type Unit of Measure Comment Comment Comment Custom Indicator Text Page 3 of 6 The World Bank Report No: ISR1332 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Health insurance management module reports include information 0 0 80 about production Date Date Date 13-Dec-2007 02-Nov-2010 31-Jan-2014 Type Unit of Measure Comment Comment Comment Custom Indicator Text Indicator Baseline Current End Target Indicator Name Value Value Value People with access to a basic package of health, nutrition, or 35.00 0.00 80.00 population services Date Date Date 13-Dec-2007 02-Nov-2010 31-Jan-2014 Type Unit of Measure Comment Comment Comment Core Indicator Number Proportion People with access to a Proportion People with access to a basic package of health in the basic package of health in the Project intervention area Project intervention area. Indicator Baseline Current End Target Indicator Name Value Value Value Pregnant women receiving antenatal care during a visit to a health 55.00 0.00 60.00 provider Date Date Date 13-Dec-2007 17-Jun-2010 31-Jan-2014 Type Unit of Measure Comment Comment Comment Core Indicator Number Proportion Proportion Intermediate Results Indicators Public Disclosure Copy Indicator Baseline Current End Target Indicator Name Value Value Value Monitoring and Evaluation of the project done with regular reports from 0 0 80 the information system providing the data Date Date Date 13-Dec-2007 17-Jun-2010 31-Jan-2014 Type Unit of Measure Comment Comment Comment Custom Indicator Text Page 4 of 6 The World Bank Report No: ISR1332 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value % of referral networks evaluated as satisfactory in the yearly quality 0 0 80 assessment Date Date Date 13-Dec-2007 17-Jun-2010 31-Jan-2014 Type Unit of Measure Comment Comment Comment Custom Indicator Text Indicator Baseline Current End Target Indicator Name Value Value Value Percentage of target population enrolled at the national level 0 0 80 Date Date Date 13-Dec-2007 17-Jun-2010 31-Jan-2014 Type Unit of Measure Comment Comment Comment Custom Indicator Text Data on Financial Performance (as of 12-Nov-2010) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P101206 IDA-43820 Effective 24-Jan-2008 19-Sep-2008 19-Jun-2009 31-Jan-2014 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P101206 IDA-43820 Effective XDR 11.70 11.70 0.00 0.68 11.02 6.00 Disbursement Graph Public Disclosure Copy Page 5 of 6 The World Bank Report No: ISR1332 Public Disclosure Copy Key Decisions Regarding Implementation Restructuring of the project would synergize with Government actions towards the launching of the new Unified Health System. It is expected to have a final agreement for the project restructuring by April 2011. Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Public Disclosure Copy Page 6 of 6