The World Bank Report No: ISR13321 Implementation Status & Results Tunisia Community Health Collaborative JSDF (P125657) Public Disclosure Copy Operation Name: Community Health Collaborative JSDF (P125657) Project Stage: Implementation Seq.No: 4 Status: ARCHIVED Archive Date: 05-Mar-2014 Country: Tunisia Approval FY: 2011 Product Line: Recipient Executed Activities Region: MIDDLE EAST AND NORTH AFRICA Lending Instrument: Technical Assistance Loan Implementing Agency(ies): Key Dates Board Approval Date 24-Mar-2011 Original Closing Date 22-Nov-2015 Planned Mid Term Review Date 30-May-2014 Last Archived ISR Date 15-May-2013 Effectiveness Date 18-Jul-2012 Revised Closing Date 22-Nov-2015 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The main objective of this Grant is to improve the quality and responsiveness of health service delivery for reproductive health through community involvement and empowerment in planning and delivering health services in under-served areas of the Republic of Tunisia's peri-urban and rural governorates in the southeast (Tataouine), central west (Kasserine), and northwest (Jendouba). Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Community Education and Mobilization 0.44 Community Outreach and Master Planning for Improving Delivery of Maternal Care 0.19 Health Services Delivery Performance Monitoring 0.23 Overall Ratings Public Disclosure Copy Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Moderate Implementation Status Overview This JSDF Grant (US$878,550) was declared effective on July 18, 2012. Project implementation has picked up considerably since the last implementation status report completed in May 2013. A central level project team at the "Direction de soins de santé de base" (DSSB), Ministry of Health, has recruited a financial/administrative management specialist a technical Page 1 of 4 The World Bank Report No: ISR13321 specialist in reproductive health and a project secretary/ administrative assistant. An implementation plan and procurement plan through March 2014 is currently being implemented by the DSSB, in line with the Operational Manual and procurement plan of the project. A contract between the DSSB and a national NGO (ATSR- Association Tunisienne de la santé pour la réproduction) signed on March 18, 2013 is currently being implemented and an Public Disclosure Copy initial report of activities has been prepared. The project is being implemented in two designated municipalities per governorate, selected due to their particularly poor maternal health and remoteness of the communities from health services. Project activities completed include the following: Component 1 – Community mobilization: - Finalization of technical guidelines for community participation in the project adapted to the Tunisian context, following a series of workshops with local authorities, CSOs and community members. This document was prepared by the project coordinator and a consultant hired to train the various committees of the project and validated by the Director of the Project, DSSB Director (MOH direction de soins de santé de base / primary health care) and other members of the technical management team. Component 2 - Participatory service delivery planning: - Organization of two workshops on concepts and techniques of community participation and participatory planning of health services to implement and hardware acquisitions to engage in the project. These workshops were used to conduct a diagnostic of current challenges in terms of access and quality of maternal services, to rank challenges, analyze causes, propose solutions and plan the implementation of these solutions. In the municipality of Tataouine in Tataouine (September 3-6, 2013), 36 beneficiaries participated; in the municipality of Ain Drahem, Jendouba (Sept 9-12, 2013), 29 beneficiaries participated. - These activities fed into joint planning exercises, developed and finalized among health professionals (regional and local), representatives of other sectors outside health, local NGO representatives and members of citizens health committees created under the project. These seminars were prepared and organized by the PIU and facilitated and by a specialist consultant and the national project coordinator. Component 3 – Participatory Monitoring and Evaluation: - Results framework of the project has been updated with technical, intermediate indicators for project activities as well as the final outcomes indicators (see attached updated Results Framework) - Local baseline community scorecards, approximately 2 per each of the 3 governorates in addition to local stakeholder interviews, were completed during September 2013 in collaboration with ATSR serving as a baseline “participatory diagnostic” (DP) of current challenges facing local communities (see ATSR DP Reports attached). Preliminary results show the following challenges common to all three governorates (with selected solutions to be supported by the project): o Limited awareness and participation: Access to information and awareness of reproductive/maternal health issues and services remains limited among both females and males, limiting use of services (a key area of intervention for the project through partnership with ATSR and local citizens committees) Public Disclosure Copy o Structural constraints: A lack of equipment/infrastructure and specialist doctors was cited frequently. o Socio-cultural factors: Factors such as social solidarity and reliance on family structures for support and information, acceptability of family planning (notably among males) and women’s public participation were among key factors influencing awareness of and access to services. Locations Country First Administrative Division Location Planned Actual Tunisia Gouvernorat de Tataouine Gouvernorat de Tataouine ✔ Page 2 of 4 The World Bank Report No: ISR13321 Tunisia Gouvernorat de Jendouba Gouvernorat de Jendouba ✔ Tunisia Gouvernorat de Kasserine Gouvernorat de Kasserine ✔ Public Disclosure Copy Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Births attended by skilled personnel in rural Percentage Value 65.00 65.00 85.00 regions (%) Date 18-Jul-2012 01-Dec-2013 01-Nov-2013 Comments Values reflect baseline values as these have yet to be assessed (planned by mid 2014). Proportion of women waiting 4 hours or less for Percentage Value 30.00 30.00 80.00 ambulatory care (general; obstetrics and Date 18-Jul-2012 01-Dec-2013 01-Nov-2013 gynecology) Comments Values reflect baseline values as these have yet to be assessed (planned by mid 2014). Proportion of citizens satisfied or very satisfied Percentage Value 55.00 55.00 70.00 with maternal health services (% of women Date 18-Jul-2012 01-Dec-2013 01-Nov-2013 satisfied or verysatisfied) Comments Values reflect baseline values as these have yet to be assessed (planned by mid 2014). Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Public Disclosure Copy Proportion of women receiving antenatal care Percentage Value 40.00 40.00 70.00 (4 visits) Date 18-Jul-2012 01-Dec-2013 01-Nov-2013 Comments Values reflect baseline values as these have yet to be assessed (planned by mid 2014). Data on Financial Performance (as of 08-Nov-2013) Financial Agreement(s) Key Dates Page 3 of 4 The World Bank Report No: ISR13321 Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P125657 TF-99374 Effective 21-Nov-2011 22-Nov-2011 18-Jul-2012 22-Nov-2015 22-Nov-2015 Disbursements (in Millions) Public Disclosure Copy Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P125657 TF-99374 Effective USD 0.88 0.88 0.00 0.24 0.64 27.00 Disbursement Graph Key Decisions Regarding Implementation A mid-term evaluation of the project is planned to assess results and revise the implementation plan as needed to accelerate progress and ensure realistic results targets. Public Disclosure Copy Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Page 4 of 4