Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) Nigeria States Health Investment Project (P120798) AFRICA WEST | Nigeria | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2012 | Seq No: 19 | ARCHIVED on 18-Nov-2020 | ISR43550 | Implementing Agencies: Federal Ministry of Health, Federal Ministry of Finance, Federal Ministry of Finance, Federal Ministry of Finance, IERD/FMoF, National Primary Health Care Development Agency, Ministry of Finance, FMOH, FMOH (FED. MIN. OF HEALTH) Key Dates Key Project Dates Bank Approval Date: 12-Apr-2012 Effectiveness Date: 20-Aug-2013 Planned Mid Term Review Date: 09-Oct-2017 Actual Mid-Term Review Date: 27-Nov-2017 Original Closing Date: 30-Jun-2018 Revised Closing Date: 31-Oct-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase the delivery and use of high impact maternal and child health interventions and improve quality of care at selectedhealth facilities in the participating states. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured)HRPDODELs To increase the delivery and use of high impact maternal and child health interventions and improve quality of care available to the people in Nasarawa and Ondo and all the States in the NE. Components Table Name Component 1: Strengthening Service Delivery:(Cost $225.60 M) Component 2: Technical Assistance to the States:(Cost $69.60 M) Component 3 (NEW): Partnerships for strengthening service delivery:(Cost $18.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions 11/18/2020 Page 1 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) The project has been extended for four months from 30 June 2020 to 31 October 2020 to enable project states that had funds remaining to effectively program these for the COVID-19 response. Project funds have been re-programmed in decentralized health facility financing to enable local health managers and their communities to respond to the COVID-19 pandemic. The Project Development Objective “To increase the delivery and use of high impact maternal and child health interventions and improve quality of care available to the people in Nasarawa and Ondo and all the States in the NE” is rated as moderately satisfactory. The reason for the moderately satisfactory rating is that the project objectives remain highly relevant, the PDO has been substantially achieved and the efficiency of the operation is substantial. In terms of Implementation Progress, it is rated Satisfactory (S) overall. mpaTable Multiphase Programmatic Approach (MPA) Status mpaTableBody Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- High High Sector Strategies and Policies -- Moderate Moderate Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and -- Substantial Substantial Sustainability Fiduciary -- High High Environment and Social -- Moderate Moderate Stakeholders -- Substantial Substantial Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes To increase the delivery and use of high impact MCH interventions and improve quality in 8 states IN00895224 ►1. Proportion of children sick in the last month who used a government hospital or clinic (average of Adamawa, Bauchi, Borno, Gombe, Taraba and Yobe) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 61.70 69.10 69.10 72.00 11/18/2020 Page 2 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) Date 01-Jan-2016 30-Jun-2020 30-Jun-2020 30-Oct-2020 NEW PDO level indicator from the additional financing results framework. Comments: IN00895225 ►2. Number of outpatient visits per year, children and adults (sum of Adamawa, Bauchi, Borno, Gombe, Taraba and Yobe) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 169,666.00 19,408,022.00 20,936,636.00 500,000.00 Date 31-Dec-2014 30-Jun-2020 30-Sep-2020 30-Oct-2020 Indicator from the additional financing results framework. On reviewing the final ISR, the team opinions Comments: that the baseline should be 0, as services start being delivered from day 1. IN00895226 ►3. Proportion of children sick in the last month who used a government hospital or clinic (average of Nasarawa and Ondo) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 55.70 55.40 55.40 85.00 Date 01-Jan-2014 30-Jun-2020 30-Jun-2020 30-Jun-2020 Indicator from the results framework of the additional financing. Comments: IN00895227 ►4. Average Health Facility Score - Structural Quality of Care (average of Adamawa, Bauchi, Borno, Gombe, Taraba and Yobe) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 41.00 41.00 61.60 72.00 Date 30-Dec-2016 30-Jun-2020 30-Sep-2020 30-Oct-2020 Indicator from the additional financing results framework. On calculating the end result, extracting from the Comments: annual QoC survey of the SOMIL, we find that the baseline should have been 40% (instead of 41%). IN00895228 ►5. Average Health Facility Score - Structural Quality of Care (average of Nasarawa and Ondo) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 42.30 42.30 60.20 72.00 Date 30-Dec-2016 30-Jun-2020 30-Sep-2020 30-Jun-2020 From the additional financing results framework. On calculating the end result, extracting from the annual Comments: QoC survey of the SOMIL, we find that the baseline should have been 40.7% (instead of 42.3%). IN00895229 ►6. Proportion of skilled births attended by skilled health personnel (average of Nasarawa and Ondo) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 56.00 59.00 73.55 75.00 Date 31-Dec-2014 30-Jun-2020 30-Jun-2020 30-Jun-2020 Indicator from the additional financing results framework. Comments: 11/18/2020 Page 3 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) IN00895230 ►7. Proportion of skilled births attended by skilled health personnel (average of Adamawa, Bauchi, Borno, Gombe, Taraba and Yobe) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 30.00 47.20 35.00 Date 31-Dec-2014 30-Jun-2020 30-Jun-2020 30-Oct-2020 Indicator from the additional financing results framework. Comments: IN00895231 ►8. Percentage of 12-23 month old children vaccinated with Penta3 (NE) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 27.40 48.80 68.60 49.00 Date 31-Dec-2010 30-Jun-2020 30-Jun-2020 30-Oct-2020 IN00895232 ►9. Number of 0-12 month old children vaccinated with Penta3 (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 270,644.00 1,337,779.00 1,373,728.00 2,500,000.00 Date 31-Dec-2010 30-Jun-2020 30-Jun-2020 30-Jun-2020 Indicator from the additional financing results framework. On reviewing the final ISR, the team opinions Comments: that the baseline should be 0, as services start being delivered from day 1. IN00895233 9A. Number of 0-12 month old children vaccinated with Penta3 (Nasarawa) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 86,237.00 419,979.00 428,729.00 450,000.00 Date 31-Dec-2010 30-Jun-2020 30-Jun-2020 30-Jun-2020 IN00895234 9B. Number of 0-12 month old children vaccinated with Penta3 (Ondo) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 106,227.00 918,300.00 944,999.00 700,000.00 Date 31-Dec-2010 30-Jun-2020 30-Jun-2020 30-Jun-2020 IN00895235 ►10. Number of 0-12 month old children vaccinated with Penta3 (NE) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78,180.00 1,087,090.00 1,339,222.00 1,350,000.00 Date 31-Dec-2010 30-Jun-2020 30-Sep-2020 30-Oct-2020 On reviewing the final ISR, the team opinions that the baseline should be 0, as services start being Comments: delivered from day 1. IN00895236 11/18/2020 Page 4 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) ►11A. Percentage of 12-23 month old children vaccinated with Penta3 (Nasarawa) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 39.40 58.80 82.90 65.00 Date 31-Dec-2010 30-Sep-2019 30-Sep-2019 30-Jun-2020 IN00895237 ►11B. Percentage of 12-23 month old children vaccinated with Penta3 (Ondo) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 67.30 72.20 86.60 75.00 Date 31-Dec-2010 30-Sep-2019 30-Sep-2019 30-Jun-2020 IN00895238 ►12. Births (deliveries) attended by skilled health personnel (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 76,960.00 1,870,406.00 2,095,628.00 700,000.00 Date 31-Dec-2014 30-Jun-2020 30-Sep-2020 30-Oct-2020 This indicator measures the cumulative number of women who delivered with the assistance of a health provider as a result of Bank-financed activities. On reviewing the final ISR, the team opinions that the Comments: baseline should be 0, as services start being delivered from day 1. IN00895239 Proportion of births attended by skilled health personnel (NE) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 55.50 70.30 68.60 75.00 IN00895240 Proportion of births attended by skilled health personnel (Nasarawa) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 62.50 68.00 64.40 75.00 IN00895241 Proportion of births attended by skilled health personnel (Ondo) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 55.50 70.30 82.70 75.00 IN00895242 13A. Number of births attended by skilled health personnel (Nasarawa) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 11,584.00 334,171.00 334,171.00 150,000.00 Date 31-Dec-2014 30-Jun-2020 30-Jun-2020 30-Jun-2020 IN00895243 13B. Number of births attended by skilled health personnel (Ondo) (Number, Custom Breakdown) 11/18/2020 Page 5 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) Baseline Actual (Previous) Actual (Current) End Target Value 29,247.00 536,646.00 543,136.00 150,000.00 Date 31-Dec-2014 30-Jun-2020 30-Jun-2020 30-Jun-2020 IN00895244 14. Number of births attended by skilled health personnel (NE) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 24,520.00 999,589.00 1,206,195.00 400,000.00 Date 31-Dec-2014 30-Jun-2020 30-Sep-2020 30-Oct-2020 IN00895245 ►15. Average Health Facility Quality of Care Score (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 41.90 72.00 67.00 61.00 Date 31-Mar-2014 30-Jun-2020 30-Sep-2020 30-Jun-2020 Based on a composite Health Facility Quality Index covering domains of staff presence, staff knowledge, Comments: drugs & vaccines, basic equipment, condition of infrastructure and record keeping IN00895246 ►16. Number of outpatient visits by children and adults (Nasarawa and Ondo states) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 346,990.00 10,586,618.13 10,586,618.13 13,500,000.00 Date 31-Dec-2014 30-Jun-2020 30-Jun-2020 30-Jun-2020 Number of outpatient visits by children under five at Public Primary health facilities in Nasarawa and Ondo states. Cumulative value, as reported through the NHMIS. On reviewing the final ISR, the team opinions Comments: that the baseline should be 0, as services start being delivered from day 1. IN00895247 ►17. Direct project beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 20,723,573.43 22,390,040.00 12,000,000.00 Date 31-Dec-2010 30-Jun-2020 30-Sep-2020 30-Oct-2020 Direct beneficiaries as originally defined by the project are different from the definition of 'direct beneficiaries' as through the Corporate Results Indicators. Originally, direct beneficiaries are drawn from the performance-based database, from a sum of all services provided at health center and hospital levels, Comments: through the purchased health packages. Whereas the corporate results indicators reflect unique individuals, the 'direct beneficiaries' as defined here might include some duplicates. IN00895248 Female beneficiaries (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 63.00 63.00 60.00 11/18/2020 Page 6 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) Overall Comments PDO On reviewing the final ISR, the team opinions that where quantities are reported, baselines should be 0, as services start being delivered from day 1. This has no effect on overall results, however we wanted to point this out to the ICR author. Intermediate Results Indicators by Components Component 1: Strengthening Service Delivery and Institutional Peformance IN00895249 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 20,723,573.00 23,909,634.00 6,900,000.00 Date 02-Oct-2013 30-Jun-2020 30-Sep-2020 30-Oct-2020 Official CRI indicators; consisting of (1) Total number of fully vaccinated children; (2) Total number of institutional deliveries; (3) The total number of women who received nutritional services (First ANC visits before 20 weeks; Post natal care visits); (4) growth monitoring visits children 0-59 months. For Comments: approximating individuals, we limited ANC to one service only, and we also used normative visits for growth monitoring; we assumed 4 such visits per year for each individual child. IN00895252 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 0.00 12,434,144.00 15,063,069.00 3,800,000.00 IN00895253 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,967,464.00 2,193,415.00 2,500,000.00 Date 02-Oct-2013 30-Jun-2020 30-Sep-2020 30-Oct-2020 IN00895254 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 16,885,704.00 19,620,631.00 3,700,000.00 Date 02-Oct-2013 30-Jun-2020 30-Sep-2020 30-Oct-2020 IN00895255 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,870,406.00 2,095,628.00 700,000.00 Date 02-Oct-2013 30-Jun-2020 30-Sep-2020 30-Oct-2020 IN00895256 11/18/2020 Page 7 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) ►18. Proportion of health facilities with functioning management committees (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 30.00 Date 30-Dec-2016 30-Jun-2020 30-Sep-2020 30-Oct-2020 Indicator from the additional financing results framework Comments: IN00895257 ►19. Number of mobile clinics in project areas (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 51.00 44.00 75.00 Date 30-Dec-2016 30-Jun-2020 30-Sep-2020 30-Oct-2020 Indicator added in the additional financing results framework Comments: IN00895258 ►20. Number of women receiving counseling on gender based violence or mental health services from a trained provider (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 20,000.00 Date 30-Dec-2016 30-Jun-2020 30-Sep-2020 30-Oct-2020 Indicator added in the additional financing results framework Comments: IN00895259 ►21. Proportion of pregnant women tested for HIV and who received test results (NE) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 39.00 42.00 58.70 50.00 Date 30-Dec-2016 30-Jun-2020 30-Sep-2020 30-Oct-2020 Indicator added in the additional financing results framework. Comments: IN00895260 ►22. Proportion of pregnant women tested for HIV and who received test results (Ondo and Nasarawa) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 37.00 45.00 63.65 50.00 Date 30-Dec-2016 30-Jun-2020 30-Sep-2020 30-Jun-2020 Indicator added in the additional financing results framework Comments: IN00895261 ►23. Proportion of mothers aged 15 to 19 years of age who delivered in the last two years and who received birth attendance (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 25.00 32.00 47.20 30.00 11/18/2020 Page 8 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) Date 31-Dec-2014 30-Jun-2020 30-Sep-2020 30-Oct-2020 Indicator added in the additional financing results framework Comments: IN00895262 ►24. Number of children treated for severe acute or chronic malnutrition per year in the project area (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 236,424.00 304,343.00 25,000.00 Date 30-Dec-2016 30-Jun-2020 30-Sep-2020 30-Oct-2020 Indicator added in the additional financing results framework Comments: IN00895263 ►25. Number of LGA with ongoing PBF (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 108.00 113.00 80.00 Date 31-Dec-2011 30-Jun-2020 30-Sep-2020 30-Oct-2020 Comments: Measured by the actual number of LGAs where facilities receive performance-based payments IN00895264 Number of LGA with ongoing PBF (NE) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 77.00 82.00 64.00 Date 02-Oct-2013 30-Jun-2020 30-Sep-2020 30-Oct-2020 IN00895265 Number of LGA with ongoing PBF (Nasarawa) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 13.00 13.00 7.00 Date 02-Oct-2013 30-Jun-2020 30-Jun-2020 30-Jun-2020 IN00895266 Number of LGA with ongoing PBF (Ondo) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 18.00 18.00 9.00 Date 02-Oct-2013 30-Jun-2020 30-Jun-2020 30-Jun-2020 Component 2: Technical Support IN00895250 ►Proportion of primary health facilities having essential medicines and commodities in stock (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/18/2020 Page 9 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) Value 0.00 76.00 53.00 35.00 Date 02-Oct-2013 30-Jun-2020 30-Sep-2020 30-Oct-2020 Numerator: Number of facilities having essential medicines and medical supplies Comments: Denominator: Number of facilities surveyed for quality IN00895251 ►Proportion of on-duty technical staff present at health facility on the day of the survey (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 72.00 63.60 84.00 Date 02-Oct-2013 30-Jun-2020 30-Jun-2020 30-Oct-2020 Numerator: Number on duty technical staff present on the day of survey Denominator: the results represent the percentage of health workers who were on duty and present in the facility on the day of the Comments: survey. All health workers who were away from work because they were doing outreach or on mission were counted as present. Drawn from the annual health facility survey from the SOML. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P120798 IDA-50940 Closed USD 150.00 150.00 0.00 136.36 1.87 99% P120798 IDA-58510 Closed USD 125.00 100.00 25.00 86.62 11.20 89% P120798 TF-13432 Closed USD 21.70 21.70 0.00 20.17 1.53 93% P120798 TF-A2591 Closed USD 20.00 20.00 0.00 12.27 7.73 61% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P120798 IDA-50940 Closed 12-Apr-2012 16-Apr-2013 20-Aug-2013 30-Jun-2018 31-May-2020 P120798 IDA-58510 Closed 07-Jun-2016 30-Aug-2016 27-Feb-2017 30-Jun-2020 31-Oct-2020 P120798 TF-13432 Closed 16-Apr-2013 16-Apr-2013 20-Aug-2013 30-Jun-2018 31-May-2020 P120798 TF-A2591 Closed 02-May-2016 30-Aug-2016 27-Feb-2017 30-Jun-2020 31-Oct-2020 Cumulative Disbursements 11/18/2020 Page 10 of 11 Public Disclosure Copy The World Bank Implementation Status & Results Report Nigeria States Health Investment Project (P120798) Restructuring History Level 2 Approved on 30-Jun-2018 ,Level 2 Approved on 08-Aug-2019 ,Level 2 Approved on 12-Apr-2020 ,Level 2 Approved on 22-Jun-2020 Related Project(s) P149936-Nigeria State Health Investment Project (NSHIP) Additional Financing ,P157977-Additional Financing Nigeria State Health Investment Project 11/18/2020 Page 11 of 11