The World Bank Implementation Status & Results Report Nigeria - Program to Support Saving One Million Lives (P146583) Nigeria - Program to Support Saving One Million Lives (P146583) AFRICA WEST | Nigeria | Health, Nutrition & Population Global Practice | Requesting Unit: AWCW2 | Responsible Unit: HAWH2 IBRD/IDA | Program-for-Results Financing | FY 2015 | Team Leader(s): Ayodeji Gafar Ajiboye Seq No: 9 | ARCHIVED on 06-Jul-2020 | ISR42446 | Created by: Ayodeji Gafar Ajiboye on 17-Jun-2020 | Modified by: Ayodeji Gafar Ajiboye on 26- Jun-2020 Program Development Objectives Program Development Objective (from Program Appraisal Document) The objective of the Program is to increase the utilization and quality of high impact reproductive, child health and nutrition interventions. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Implementation Status and Key Decisions Despite the COVID-19 pandemic which has crippled activities in Nigeria's health sector and economy, there have been significant positive developments on key program surveys and results. This ISR provides updates on these issues since the last ISR in December 2019. One national survey has been completed with results showing improvement in quality of healthcare delivery while the analysis of the results of the second survey is ongoing following completion of fieldwork. The two surveys are the National Health Facility Survey (NHFS) and the National Nutrition and Health Survey (NNHS – known as SMART survey).  The fieldwork for NHFS was completed in November 2019 while the draft report became available in May 2020. The survey report is awaiting approval of the leadership of the FMoH and verification of results by the IVA. The NHFS, which measures the “increase in quality of high impact Reproductive, Child Health and Nutrition Interventions, will be used to gauge states’ performance on Disbursement Linked Indicator (DLI) 2. Preliminary results suggest overall improvement in the national Quality of Care (QoC) Index from baseline of 34 percent in 2016 to 52 percent in 2019, an 18 percentage points increase in three years. States’ performance shows wide variation in results as 15 of the 36 states (and FCT) performed above the national average. Only one state did not record any improvement in the QoC index. Clinical competence, the diagnostic accuracy of health workers and adherence to clinical guidelines, is the area that showed the most improvement with 5.5 percentage points above the baseline of 8.5 percent. Financial management and quality of HMIS data is the least improved area with 1 percentage points above the baseline of 4.7 percent. Other improved results areas include increased availability of drugs and equipment by 4.1 percentage points from a baseline of 5.9 percent; increase in frequency and quality of supervision by 4.6 percentage points from a baseline of 8.6 percent; and readiness to deliver key SOML services increasing by 2.6 percentage points from a baseline of 6.1 percent. Once the survey report is approved by the leadership of FMOH and results are verified by the IVA, the verified results will be subsequently presented to the National Steering Committee of SOML PforR for approval before disbursement of funds.  The fieldwork for the NNHS (known as SMART survey] was completed in February 2020. Analysis in ongoing following the completion of data cleaning. Early results were presented to the Survey Management Committee in June 2020 and a draft report is expected to be ready by July 2020, which will then be followed by required approvals and verification. The results of the SMART survey will form the basis for disbursements against DLI 1.2 focusing on increase in utilization of six key health services.  Lastly, the completion of both surveys (NHFS and SMART) by the FMoH makes them eligible to receive an additional disbursement on DLI 3.1 [for implementation of both surveys] and on DLI 3.2 for the publication of survey results on a national media platform. Data on Financial Performance Disbursements (by loan) 7/6/2020 Page 1 of 11 The World Bank Implementation Status & Results Report Nigeria - Program to Support Saving One Million Lives (P146583) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P146583 IDA-56000 Effective USD 500.00 500.00 0.00 262.43 231.92 53% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P146583 IDA-56000 Effective 23-Apr-2015 22-May-2015 29-May-2015 31-Dec-2019 30-Sep-2020 DLI Disbursement Achievement Disbursed amount in Disbursement % for DLI ID DLI Type Description Coc DLI Amount Status Coc DLI Loan: IDA56000-001 Incr of utilsn of HIR,Chld Partially 1 Regular XDR 216,400,000.00 158,627,731.17 73 % Health&Nutrti Achieved Incr of utilsn of HIR,Chld 2 Regular XDR 38,300,000.00 Not Achieved 0.00 Health&Nutrti Imprvt of mntrg&eval Partially 3 Regular XDR 56,800,000.00 19,348,217.80 34 % systm&data utilsn Achieved 4 Regular Esbls&Oprt Invtion Fund XDR 14,200,000.00 Not Achieved 0.00 Incrs transpcy in Partially 5 Regular XDR 29,000,000.00 6,557,896.83 23 % mgmt&bdgt of PHC Achieved Program Action Plan Action Description Prepare standardized template for financial reporting and pilot and roll-out at facilities Source DLI# Responsibility Timing Timing Value Status Other Client Due Date 28-Nov-2016 Completed Completion Measurement Annual reports on facility sources and uses of funds published conspicuously at facility level. This activity is noted to be carried out as represented in the 2016 National Health Facility Survey as well as the about Comments to released 2019 Survey. Publish annual consolidated PHC expenditure report for the state based on 3 economic classifications: Action Description compensation; goods & services; investments. Source DLI# Responsibility Timing Timing Value Status Other DLI 10 Client Recurrent Yearly In Progress Completion Measurement Consolidated PHC expenditure report published on state government website. Assessments of DLI 5 are being undertaken by the IVA. So far the IVA has verified that seven (7) states in the Comments country have successfully generated consolidated PHC budget execution reports and published them. 7/6/2020 Page 2 of 11 The World Bank Implementation Status & Results Report Nigeria - Program to Support Saving One Million Lives (P146583) Annual federal level budget execution report prepared at the economic (object) classification level for PHC sub- Action Description function (SOML-focused) Source DLI# Responsibility Timing Timing Value Status Other DLI 11 Client Recurrent Yearly In Progress Completion Measurement Federal budget excution report. Assessments of DLI 5 to be undertaken by the IVA. Comments PMU in the FMOH has at least 1 financial management staff that focus on SOML management, monitoring, and Action Description reporting. Source DLI# Responsibility Timing Timing Value Status Other Client Recurrent Monthly Completed Completion Measurement Staff with requisite skills are working full time in the PMU. Comments The PMU has three full-time accounts - 2 of which are Chartered accountants. Internal audit units in FMOH assign internal auditors for ex-poste systemic and risk-based audits of the Program and Action Description report quarterly to permanent secretary, FMOH after capacity strengthening in risk-based internal audits. Source DLI# Responsibility Timing Timing Value Status Other Client Recurrent Quarterly In Progress Completion Measurement Quarterly internal audit reports. Comments The PMU has a full-time internal auditor. Procurement plans for SOML related activities to be prepared by FMOH and approved by Minister or permanent Action Description secretary, FMOH Source DLI# Responsibility Timing Timing Value Status Other Client Recurrent Yearly In Progress Completion Measurement Procurement plan with approval by the appropriate authority. Comments Action Description Capacity building on procurement procedures and contract management conducted annually Source DLI# Responsibility Timing Timing Value Status 7/6/2020 Page 3 of 11 The World Bank Implementation Status & Results Report Nigeria - Program to Support Saving One Million Lives (P146583) Other Client Recurrent Continuous In Progress Completion Measurement Attendance sheet, increased use of BPP standard templates. Comments In accordance with 2007 Procurement Act an independent procurement audit will be conducted on random sample of Action Description at least 5% of transactions under the SOML program. Source DLI# Responsibility Timing Timing Value Status Other Client Recurrent Continuous In Progress Completion Measurement Procurement audit report. Comments Fraud and corruption complaints redress - Formal policy and procedural guidance prepared and approved as Action Description applicable to the program Source DLI# Responsibility Timing Timing Value Status Other Client Recurrent Continuous In Progress Documented policy & procedures, with assigned Completion Measurement responsibilities and oversight. The Anti-Corruption and Transparency Unit of the ICPC is domiciled in the Permanent Secretary’s Office and handles Comments fraud and corruptions related complaints. Strengthen capacity of ACTU network to deliver on mandate – assign full time staff with mandate and resources and Action Description build on the risk assessment at the level of primary health centers led by the ICPC. Source DLI# Responsibility Timing Timing Value Status Other Client Recurrent Continuous In Progress Additional full-time staff assigned to ACTU and resources budgeted in FMOH annual Completion Measurement budgets. Preventive measures to be agreed on based on the findings of the risk assessment. Comments Action Description Undertake an expenditure tracking survey, focusing on financial and commodity flows that are critical to SOML results 7/6/2020 Page 4 of 11 The World Bank Implementation Status & Results Report Nigeria - Program to Support Saving One Million Lives (P146583) Source DLI# Responsibility Timing Timing Value Status Other Client Due Date 28-May-2016 Completed Completed report with recommendations about recording & reporting at the facility Completion Measurement level. Comments Action Description Establish communication strategy for stakeholder engagement Source DLI# Responsibility Timing Timing Value Status Other Client Due Date 28-May-2016 Completed Plan to inform stakeholders on SOML PforR and the results achieved. Completion Measurement The PMU established a Communication Action Plan which outlines the strategy for stakeholder engagement. Comments Action Description Capacity building for FMOH staff and other health workers on health care waste management and equity issues. Source DLI# Responsibility Timing Timing Value Status Other Client Recurrent Continuous In Progress Completion Measurement Attendance sheets. Comments Action Description Carry out annual assessment of progress on environmental and social issues. Source DLI# Responsibility Timing Timing Value Status Other Client Recurrent Continuous In Progress Report on progress related to health care waste management Completion Measurement and equity issues. Conducted in the latest National Health Facility Survey which contains some questions on health care waste Comments management (HCWM). However, the questions in the survey did not satisfactorily cover all of the requirements of the ESSA and PAP on HCWM. 7/6/2020 Page 5 of 11 The World Bank Implementation Status & Results Report Nigeria - Program to Support Saving One Million Lives (P146583) Timely transfer of Financing proceeds to States through government processes for results achieved by the states Action Description under DLIs 1, 2, 3, and 5 Source DLI# Responsibility Timing Timing Value Status Other Client Recurrent Continuous In Progress Completion Measurement These have been carried out without delay. Disbursement in tranches was agreed between the Bank and Government during the last round of disbursement. Comments Subsequent disbursements will not follow the same pattern. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Substantial Substantial Sector Strategies and Policies -- Substantial Substantial Technical Design of Project or Program -- Substantial Substantial Institutional Capacity for Implementation and -- Substantial Substantial Sustainability Fiduciary -- Substantial Substantial Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial Substantial RiskComments Comments The task team has reviewed the SORT and is retaining the current ratings Results PDO Indicators by Objectives / Outcomes Increased utilization and quality of high impact interventions IN00861953 ►Combined coverage of six key SOML services; (a) vaccination coverage among young children (Penta3); (b) contraceptive prevalence rate (modern methods); (c) Vitamin A supplementation among children 6 m (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 237.60 244.00 244.00 284.00 7/6/2020 Page 6 of 11 The World Bank Implementation Status & Results Report Nigeria - Program to Support Saving One Million Lives (P146583) Date 06-Apr-2015 06-Dec-2018 06-Dec-2018 30-Sep-2020 Comments IN00861954 ►Quality of care index at health center level based on 6 domains with data from national health facility survey (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 38.10 38.10 38.10 42.00 Date 06-Dec-2017 06-Dec-2017 18-Dec-2017 30-Sep-2020 This indicator combines the following domains: (a) clinical competence of health workers; (b) availability of drugs and minimum equipment; (c) readiness to deliver SOML activities including outreach; (d) the quality Comments and frequency of supervision of public primary health care facilities; (e) health management information system and proper financial management; and (f) health care waste management. The end target is an increase of 50% of a baseline standard deviation. Intermediate Results Indicators by Results Areas Improved Management of Primary Health Care IN00861955 ►Number of States with performance management systems in place (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 33.00 36.00 30.00 Date 31-Jan-2015 20-Feb-2019 18-Apr-2019 30-Sep-2020 As verified by the IVA, 35 states and the FCT have achieved some or all aspect related to the Comments implementation of performance management systems IN00862042 ►States in which SPHCDA or equivalent have managerial authority over PHC staff (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 4.00 5.00 14.00 37.00 Date 31-Jan-2015 06-Dec-2018 18-Apr-2019 30-Sep-2020 As per IVA report, 14 states have moved personnel files of frontline health workers to the appropriate Comments management entity (SPHCDA) Improve quality of care and ability to deliver key SOML Interventions IN00862041 ►Impact evaluation of Results based disbursements for MNCH weeks (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 31-May-2015 07-Dec-2017 07-Dec-2017 30-Sep-2020 7/6/2020 Page 7 of 11 The World Bank Implementation Status & Results Report Nigeria - Program to Support Saving One Million Lives (P146583) Comments IN00862043 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 9,456,221.00 9,652,568.00 9,652,568.00 10,667,509.00 Date 15-Dec-2015 06-Dec-2018 06-Dec-2018 30-Sep-2020 Comments IN00862044 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 9,456,221.00 8,688,455.00 8,688,455.00 10,667,509.00 IN00862045 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 3,343,939.00 3,601,722.00 3,601,722.00 3,944,000.00 Date 15-Dec-2015 06-Dec-2018 06-Dec-2018 30-Sep-2020 IN00862046 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 2,871,128.00 2,871,128.00 2,871,128.00 3,158,240.00 Date 15-Dec-2015 06-Dec-2018 06-Dec-2018 30-Sep-2020 IN00862047 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 3,241,154.00 3,973,200.00 3,973,200.00 3,565,269.00 Date 15-Dec-2015 06-Dec-2018 06-Dec-2018 30-Sep-2020 Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 DLI 1: Increase of utilization of High Impact Reproductive, Child Health and Nutrition Interventions - DLI 1.1 States produce plans for achieving reductions in maternal, perinatal and under-5 mortalit (Process, 57,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Annual Value 0.00 37.00 37.00 37.00 7/6/2020 Page 8 of 11 The World Bank Implementation Status & Results Report Nigeria - Program to Support Saving One Million Lives (P146583) Date 29-May-2015 06-Dec-2018 06-Dec-2018 -- Comments ►DLI 2 DLI 1: Increase of utilization of High Impact Reproductive, Child Health and Nutrition Interventions - DLI 1.2 Improvements on 6 key health indicators (Intermediate Outcome, 232,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Annual Value 273.60 244.00 244.00 284.00 Date 30-Nov-2015 08-Dec-2018 08-Dec-2018 -- Comments ►DLI 3 DLI 1: Increase of utilization of High Impact Reproductive, Child Health and Nutrition Interventions - DLI 1.3 Lagging States strengthen their MNCH weeks as part of an impact evaluation (Output, 16,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Annual Value 0.00 0.00 0.00 21.00 Date 29-May-2015 06-Dec-2018 06-Dec-2018 -- Comments ►DLI 4 DLI 2: Increase of quality of High Impact Reproductive, Child Health and Nutrition Interventions (Intermediate Outcome, 54,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Annual Value 34.40 34.40 34.40 34.40 Date 30-Dec-2016 06-Dec-2018 06-Dec-2018 -- Health facility survey data not yet available but will be for next ISR Comments ►DLI 5 DLI 3: Improvement of monitoring and evaluation systems and data utilization - DLI 3.1 Improving M&E Systems (Process, 35,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Annual Value Yes Yes Yes Yes Date 31-May-2014 08-Dec-2018 08-Dec-2018 -- Comments ►DLI 6 DLI 3: Improvement of monitoring and evaluation systems and data utilization - DLI 3.2 Improving Data Utilization (Process, 27,000,000.00, 0%) 7/6/2020 Page 9 of 11 The World Bank Implementation Status & Results Report Nigeria - Program to Support Saving One Million Lives (P146583) Baseline Actual (Previous) Actual (Current) Annual Value No Yes Yes Yes Date 29-May-2015 06-Dec-2018 06-Dec-2018 -- Comments ►DLI 7 DLI 3: Improvement of monitoring and evaluation systems and data utilization - DLI 3.3 Implementing Performance Management in States (Process, 18,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Annual Value 0.00 27.00 27.00 37.00 Date 29-May-2015 06-Dec-2018 06-Dec-2018 -- Comments ►DLI 8 DLI 4: Establishment and operation of the Innovation Fund designed to support private sector innovations aimed at increasing utilization and quality of maternal and child health interventions (Output, 20,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Annual Value No No No Yes Date 29-May-2015 06-Dec-2018 06-Dec-2018 -- Comments ►DLI 9 DLI 5: Increase of transparency in management and budgeting of primary health care - DLI 5 (i) Number of States that have transferred health staff to entity responsible for PHC (Process, 18,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) Annual Value 4.00 5.00 5.00 37.00 Date 29-May-2015 08-Dec-2018 08-Dec-2018 -- Comments ►DLI 10 DLI 5: Increase of transparency in management and budgeting of primary health care - DLI 5 (ii) Number of States that have produced and published a consolidated budget execution report (Process, 20,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) Annual Value 0.00 12.00 12.00 24.00 Date 29-May-2015 08-Dec-2018 08-Dec-2018 -- Comments 7/6/2020 Page 10 of 11 The World Bank Implementation Status & Results Report Nigeria - Program to Support Saving One Million Lives (P146583) ►DLI 11 DLI 5: Increase of transparency in management and budgeting of primary health care - DLI 5 (iii) FGON publishes a consolidated budget execution report (Process, 2,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Annual Value No No No Yes Date 29-May-2015 08-Dec-2018 08-Dec-2018 -- Comments 7/6/2020 Page 11 of 11