Public Disclosure Copy The World Bank Implementation Status & Results Report Philippines Public Health (P115184) Philippines Public Health (P115184) EAST ASIA AND PACIFIC | Philippines | Health, Nutrition & Population Global Practice | Recipient Executed Activities | Specific Investment Loan | FY 2012 | Seq No: 5 | ARCHIVED on 28-Dec-2015 | ISR19353 | Implementing Agencies: DEPARTMENT OF HEALTH LN7395, PHILHEALTH Key Dates Key Project Dates Bank Approval Date:16-Mar-2011 Effectiveness Date:09-Jul-2012 Original Closing Date:31-Dec-2015 Revised Closing Date:31-Dec-2015 Project Development Objectives Project Development Objective (from Project Appraisal Document) The objective of the Project is to pilot interventions that improve the health status, particularly maternal and reproductive health, of poor populations in the province of Leyte, Southern Leyte, Samar, Northern Samar, and Eastern Samar in the Eastern Visayas Region of the Philippines. It aims to increase the uptake of health services through provision of subsidized health insurance, PhilHealth accreditation of 45 service providers, and subsidized vouchers to cover co-payments for normal spontaneous deliveries.. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Unsatisfactory  Moderately Unsatisfactory Overall Implementation Progress (IP)  Moderately Unsatisfactory  Moderately Unsatisfactory Implementation Status and Key Decisions After the project restructuring done in October 2014, it was expected that project implementation would proceed more quickly since the project design and implementation arrangements were modified in order to align the original components with current policy changes and to enable the realization of more realistic component targets. After the restructuring in late CY 2014, project implementation picked up but the achievement of revised targets still fall short of the expected outputs The project is ending by December 31, 2015. Much effort was exerted to enable the 12/28/2015 Page 1 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Philippines Public Health (P115184) accomplishment of the targets by PSPI (the recipient). Coordination was facilitated with both the Department of Health (DOH) and PhilHealth regional offices. PSPI was encouraged to reach out more to DOH regional office program staff to achieve more coordination and facilitate personnel training. Coordination meetings with both PhilHealth and DOH regional offices were facilitated during supervision missions. Regular bi-weekly coordination and updating meetings were conducted between PSPI CEO, the Bank TTL and the GPOBA coordinator in order to address immediate bottlenecks and provide quick solutions. A catch-up plan was required of and submitted by PSPI in order to also facilitate project implementation. Despite these efforts, the project has just barely achieved half of the main project component targets as of restructuring: only 34 out of 54 (62.9%) PhilHealth Maternity Care Package (MCP) accredited health facilities and only 9,831 vouchers sold out of the expected 20,000 vouchers (49.2%). Although 969 out of the targeted 1,000 Alaga Ka sessions (benefit awareness outreach sessions done in the barangays) were reportedly conducted, only 44,201 (14.8%) out of the expected 300,000 beneficiaries were reached in the sessions. The first component – MCP-accreditation with PhilHealth of private and public birthing facilities – is to provide additional access to services by pregnant women in poor communities. The target was 36 and 18 private and public birthing facilities respectively. The project was only able to accredit 27 private (75%) and 7 public (38%) birthing facilities. 12 of these facilities are located in Samar and Eastern Samar, the two provinces were the Mothers Bonus voucher system was sold and distributed and where the poverty is greater compared to the other Region 8 provinces. All these facilities are operational and have been providing much needed basic services. For Maternity Care Package accreditation with PhilHealth, the PhilHealth accreditation requirements are consistent with the Department of Heatlh licensing requirements. PhilHealth was facilitative in requests for accreditation. After project restructuring, it was recommended that PSPI focus on having more facilities accredited in Samar and Northern Samar as this was where the poorest municipalities were and where the voucher was going to be sold. In the earlier part of the project, PSPI concentrated on Leyte, Southern Leyte and Tacloban City to source the facilities for accreditation. The low private midwife facility accreditation rate was, according to PSPI, the lack of private midwives willing to participate in Samar and Northern Samar. Part of the problem too was that PSPI lost time to accredit more facilities in said areas. The IVA has reported in their quarterly report (July to September 2015) that for the 12 newly accredited private midwives facilities, most have already submitted substantial claims with PhilHealth with regard deliveries in their facilities (low of 1 with a high of 36, average of 13 for all 12 facilities). For the public facilities (barangay health stations or BHS), part of the problem was that the DOH-identified facilities were in difficult and hard-to- reach areas (purposely done during project restructuring in order to provide more equity in terms of needed services for the marginalized population) where the cost was greater than planned for and PSPI had difficulty finding contractors to work in said places. It was also a need to coordinate with the LGUs since the project financing only covered the birthing facility of the structure, and the LGU financing may have a different timeline in terms of fund availability and actual work to be done.. For the facilities that the project was able to refurbish, PhilHealth was able to grant accreditation in a short time span. Though difficult to undertake, the refurbished facilities are now providing maternity-related services for pregnant women in their catchment areas. In the same IVA report, only two (2) of the MCP-accredited BHSs have filed claims with PhilHealth. The second component, completely revised after the restructuring, aims to provide much needed information to PhilHealth members about their membership, benefits and entitlements as members. Part of this component was the production and airing of radio advertisements in both the AM and FM bands. Two 30-second radio ads were produced and then aired regularly in 7 radio stations (roughly between late August and early December 2015) that covered most of Region 8 provinces. The other part of this component was the conduct of face-to-face benefit awareness sessions (Alaga Ka) in poor barangays in the poorest provinces. The sessions were undertaken in coordination with the municipal and barangay authorities and the DSWD Municipal Links. In these sessions PhilHealth members were given information on their membership and benefits and were also given health services. They were also given copies of proof of their and their dependents membership with PhilHealth (Member Data Record or MDR). The Alaga Ka sessions were expected to generate an attendance of at least 300 individuals per barangay. However, the attendance in the sessions varied greatly from barangay to barangay. The Alaga Ka sessions were also conducted all over the 5 project sites and were facilitated by the support coming from the project. A total of 44,201 attendees were recorded in 969 sessions, falling way short of the expected target beneficiaries. The third component is the voucher system – this component provides cash subsidies to pregnant women in order to facilitate their access of required maternity care services. To facilitate achievement of this component, the voucher system was only put in place in the provinces of Samar and Northern Samar – two of the poorest provinces among the five project sites. Each component service (ante-, natal and post) has a cash equivalent and can be redeemed as soon as the particular service is achieved. Three redemption outlets were established (RCBC branches in Calbayog, Catarman and Catbalogan). Discussion were initiated and agreements reached with RCBC to provide additional redemption outlets (Lhuillier outlets) but was never operationalized. This was unfortunate as this could have provided more access to more mothers and would have maximized the use of their cash subsidies. In three isolated LGUs, an arrangement was reached between the LGU and PSPI for a redemption mechanism that was outside of the voucher system established with RCBC. The arrangement allowed the LGUs to disburse the cash incentives to the Mother Bonus clients and PSPI reimbursed the LGUs. The specifics of the arrangement would have to be looked at by the Bank FMS and verified by the IVA. In a project briefing done last December 16, 2015 for the Strategic Advisory Committee (SAC) for the project that was chaired by the DOH Undersecretary, the team presented the project's accomplishments. It was discussed and the Underscretary directed the team to continue discussions, even after project closure, with the DOH and PhilHealth on how to maximize the benefits of the project. The project highlighted the public-private facility synergies being created under the project. The project links both private and public PhilHealth accredited facilities with each 12/28/2015 Page 2 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Philippines Public Health (P115184) other in order to provide complementary services for poor pregnant women.The project's pilot of the voucher system was interesting for the DOH and the Underecretary wanted to explore how it could be continued by either the DOH or PhilHealth or some other organization, either in toto or modified form, in order to provide more incentives for pregnant women to seek medical services. The team emphasized that the system and procedures for continuing the voucher system was already in place and that taking over its implementation would not be so difficult. How this could be done will be part of the discussion that would be conducted. Risks Overall Risk Rating Risk Category Rating at Approval Previous Rating Current Rating Overall  Substantial  --  Substantial Comments Unable to include ORAF/SORT in the submission. Will try to append in clearance section. Risk rating during project restructuring was Substantial Ratings were as follows: High risk for Capacity of implementing agency Substantial risk for Governance and Design Moderate risk for Stakeholder, Country, Sector and Multisector, Fraud and Corruption, Social and Environmental,and Delivery Monitoring and Sustainability Low risk for Program and Donor Results Project Development Objective Indicators PHINDPDOTBL Number of project facilities accredited (by Philhealth) and delivering services for at least three months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 13.00 34.00 54.00 Date 30-Jun-2012 01-May-2014 31-Dec-2015 31-Dec-2015 Comments Indicated value is final until the end of the project. No other facilities are expected to be accredited until project closure. Breakdown of targets after restructuring is as follows: 36 private facilities and 18 public facilities. Actual accomplishment is 27 private facilities and 7 public facilities. 12/28/2015 Page 3 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Philippines Public Health (P115184) PHINDPDOTBL Percentage of pregnant woman availing 4 or more antenatal care visits (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 27.60 27.60 40.29 33.00 Date 31-Dec-2011 31-Dec-2011 22-Dec-2015 31-Dec-2015 Comments Reported data comes directly from the DOH Regional Office in Eastern Visayas and is based on latest FHSIS reports. Based on only on the information from vouchers sold, the project catered to 1,581 pregnant women who have completed 4+ antenatal checkups. Data from the other project facilities was unavailable as of this submission. PHINDPDOTBL Percentage of facility-based deliveries (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 53.70 61.60 89.67 64.00 Date 31-Dec-2011 31-Dec-2013 22-Dec-2015 31-Dec-2015 Comments Reported data comes directly from the DOH Regional Office in Eastern Visayas and is based on latest FHSIS reports. Based only on the information from vouchers sold, the project facilities have recorded 1,969 facility-based deliveries. Data from the other project facilities was unavailable as of this submission. Overall Comments Intermediate Results Indicators PHINDIRITBL Health facilities constructed, renovated, and/or equipped (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.00 34.00 54.00 Date 30-Jun-2012 23-Nov-2014 31-Dec-2015 31-Dec-2015 Comments Indicated value is final until the end of the project. No other facilities are expected to be refurbished for accreditation until project closure. Breakdown of targets after restructuring is as follows: 36 private facilities and 18 public facilities. Actual accomplishment is 27 private facilities and 7 public facilities. 12/28/2015 Page 4 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Philippines Public Health (P115184) PHINDIRITBL Health personnel receiving training (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 35.00 35.00 54.00 Date 30-Jun-2012 23-Nov-2014 31-Dec-2015 31-Dec-2015 PHINDIRITBL Direct project beneficiaries (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 61176.00 54066.00 320054.00 Date 30-Jun-2012 24-Nov-2013 11-Dec-2015 31-Dec-2015 Comments Reported figure is based on the revised formula defined after project restructuring for measuring this indicator. This is a composite of the total number of midwives trained (34), the number of Alaga Ka vouchers sold to pregnant women (9,831), and the number of attendees in the Alaga Ka sessions (44,201). PHINDIRITBL Number of quintile 2 families enrolled in Philhealth (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 52412.00 52412.00 52412.00 Date 30-Jun-2012 23-Nov-2014 23-Nov-2014 31-Dec-2015 Comments This was an original project indicator. But as explained in the previous ISRs, this was discontinued after policy changes occurred during implementation. However, this indicator was retained to document the accomplishment prior to project restructuring. Reported figure is final and no further need to update after restructuring. 12/28/2015 Page 5 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Philippines Public Health (P115184) PHINDIRITBL Number of PhilHealth members participated in at least one face-to-face awareness campaign held in the 1,000 identified poor (class 4-6) barangays (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 44201.00 300000.00 Date 30-Jun-2012 23-Nov-2014 11-Dec-2015 30-Dec-2015 Comments Reported figure is number of attendees in 969 Alaga Ka sessions conducted so far. The target is at least 300 participants per session. PHINDIRITBL Number of subsidies paid under the voucher scheme (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 3476.00 20000.00 Date 30-Jun-2012 23-Nov-2014 11-Dec-2015 30-Dec-2015 Comments The indicator targets that every voucher sold will enable a pregnant woman to avail of vital maternity care services - antenatal care, facility- based delivery and post-natal care. The reported figure reflects full redemption of all three (3) vital services among the vouchers sold. Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed 12/28/2015 Page 6 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Philippines Public Health (P115184) P115184 TF-10757 Effective USD 3.65 2.98 0.67 1.95 1.03 66% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P115184 TF-10757 Effective 10-Apr-2012 10-Apr-2012 09-Jul-2012 31-Dec-2015 31-Dec-2015 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 12/28/2015 Page 7 of 7 Public Disclosure Copy