The World Bank Report No: ISR5526 Implementation Status & Results Peru PE- (APL2) Health Reform Program (P095563) Public Disclosure Copy Operation Name: PE- (APL2) Health Reform Program (P095563) Project Stage: Implementation Seq.No: 6 Status: ARCHIVED Archive Date: 05-Aug-2011 Country: Peru Approval FY: 2009 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Adaptable Program Loan Implementing Agency(ies): Ministry of Health - Programa de Apoyo a la Reforma del Sector Salud Key Dates Board Approval Date 17-Feb-2009 Original Closing Date 31-Jan-2015 Planned Mid Term Review Date 13-Feb-2012 Last Archived ISR Date 05-Aug-2011 Effectiveness Date 15-Dec-2009 Revised Closing Date 31-Jan-2015 Actual Mid Term Review Date 16-Apr-2012 Project Development Objectives Project Development Objective (from Project Appraisal Document) Framed within the long-term objective of the Health Reform Program (APL in all its phases) to reduce maternal and infant mortality rates in the nine poorest regions of the country (Amazonas, Huanuco, Huancavelica, Ayacucho, Apurimac, Cusco, Cajamarca, Ucayali and Puno); the project development objectives are to: (i) improve family care practices for women (during pregnancy, delivery and breast-feeding), and children under the age of three; (ii) strengthen health services networks with capacity to solve obstetric, neonatal and infant emergencies and to provide comprehensive health services to women (during pregnancy, delivery and breast-feeding) and children under the age of three; and (iii) support MINSA's governance functions of regulation, quality, efficiency and equity for improving the new health delivery model of maternal and child health care in a decentralized environment. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Improving health practices at the household level for women and children under age three in rural 6.00 areas of the nine targeted Regions Increasing the capacity to provide better maternal and child health services for the poor 142.30 Public Disclosure Copy Strengthening government capacities to offer more equitable and efficient health system in a 5.20 decentralized environment Project Coordination, and Monitoring & Evaluation 8.90 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Moderate Page 1 of 5 The World Bank Report No: ISR5526 Implementation Status Overview Overall, project implementation is Satisfactory with all Project Indicators on track and others are expected to be surpassed by end of project, such as institutional births and prenatal care in rural areas. Projects targets may be adjusted during the Mid-Term Review (MTR) scheduled for April 2012, in line with a joint MTR with the IADB. To date, commitment and disbursement rates are low, mostly due to difficulties in the allocation of resources at the Government level. However, disbursements have improved with respect to the first semester. Public Disclosure Copy Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increase from 64% to 80% the share of Percentage Value 64.00 89.40 80.00 children in the nine selected regions who are exclusively breastfed until 6 months of age Date 30-Dec-2005 19-Nov-2010 30-Dec-2013 Comments Indicator achieved and surpassed. Reduce the prevalence of anemia among Percentage Value 69.50 63.00 60.00 children under age 3 in the nine regions from 69.5% (2005) to 60% (2013) Date 30-Dec-2005 09-Dec-2011 30-Dec-2013 Comments This indicator is on track to be achieved in 2013. Increase the proportion of institutional Percentage Value 44.00 64.00 78.00 deliveries in rural areas of the nine selected Regions from 44% (2005) to 78% (2013) Date 30-Dec-2005 09-Dec-2011 30-Dec-2013 Comments Progress on this indicator is very positive trend and is on track to be achieved in 2013. Increase the proportion of pregnant women of Percentage Value 20.00 67.50 45.00 the nine regions with at least 1 prenatal control during the first trismester of pregnancy from Date 30-Dec-2005 09-Dec-2011 30-Dec-2013 Public Disclosure Copy 20% (2005) to 45% (2013) Comments Target achieved. Percentage has increased substantially. Intermediate Results Indicators Page 2 of 5 The World Bank Report No: ISR5526 Indicator Name Core Unit of Measure Baseline Current End Target Component 3: % of SIS affiliated households Percentage Value 67.30 61.00 25.00 that make out-of-pocket expenditures in Date 30-Dec-2005 22-Aug-2011 30-Dec-2013 Public Disclosure Copy medicines Comments An evaluation of households out-of-pocket expenditures on medicine will be undertaken in 2012. However, progress has been made modest progress so far. Component 2: % of women satisfied with the Percentage Value 1.00 1.00 25.00 services in selected facilities by confidence index Date 30-Dec-2005 31-Oct-2011 30-Dec-2013 Comments There continue to be delays in implementing a continuous survey of confidence Index. This indicator will be re- evaluated during theMTR Component 2: % of health facilities with Percentage Value 0.00 4.00 90.00 improvement in infrastructure (minor construction and / new equipment) Date 30-Dec-2005 18-Nov-2011 30-Dec-2013 Comments Project has initiated massive infrastructure works in all regions. Component 2: % of cesareans in SIS affiliated Percentage Value 3.00 3.90 5.00 pregnant rural women Date 30-Dec-2005 31-Oct-2011 30-Dec-2013 Comments Hospitals under construction are delaying the achievement of this indicator. Component 2: % of pregnant women under SIS Percentage Value 37.00 52.30 80.00 that receive iron and folic acid supplements Date 30-Dec-2005 18-Nov-2011 30-Dec-2013 Public Disclosure Copy Comments Progress on this indicator has just begun. The Project is undertaking significant efforts to improve supply distribution in particular. Page 3 of 5 The World Bank Report No: ISR5526 Indicator Name Core Unit of Measure Baseline Current End Target Component 2: % of SIS affiliated rural pregnant Percentage Value 37.00 44.00 80.00 women with laboratory tests on hemoglobin, Date 30-Dec-2005 07-Nov-2011 30-Dec-2013 Public Disclosure Copy urine and syphilis Comments Buildings under construction, including labs in 23 hospitals, are delaying the trend for achieving this indicator. Component 1: % of children who received Percentage Value 22.60 28.80 34.00 growth and development controls (CRED) according to their age Date 30-Dec-2007 09-Dec-2011 30-Dec-2013 Comments Indicator on track to be achieved. Component 1: % of SIS affiliated children who Percentage Value 34.00 51.10 66.00 received growth and development controls (CRED) according to their age Date 30-Dec-2005 01-Jan-2011 30-Dec-2013 Comments The evaluation data on SIS population will be available in 2012. Data on Financial Performance (as of 30-Nov-2011) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P095563 IBRD-76430 Effective 17-Feb-2009 16-Nov-2009 15-Dec-2009 31-Jan-2015 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P095563 IBRD-76430 Effective USD 15.00 15.00 0.00 3.12 11.88 21.00 Public Disclosure Copy Disbursement Graph Page 4 of 5 The World Bank Report No: ISR5526 Public Disclosure Copy Key Decisions Regarding Implementation The Project's achievements on indigenous and environmental safeguards are Highly Satisfactory. Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Public Disclosure Copy Page 5 of 5