The World Bank Report No: ISR5937 Implementation Status & Results Nepal Nepal: Second HNP and HIVIAIDS Project (P117417) o 0 C Operation Name: Nepal: Second HNP and HIV/AIDS Project (P117417) Project Stage: Implementation Seq.No: 3 Status: ARCHIVED Archive Date: 06-Jun-2011 Country: Nepal Approval FY: 2010 6 Product Line: IBRD/IDA Region: SOUTH ASIA Lending Instrument: Sector Investment and Maintenance Loan 0 .Ln Implementing Agency(ies): Ministry of Health and Population 0 Key Dates :6 3 Board Approval Date 20-Apr-2010 Original Closing Date 15-Jul-2015 Planned Mid Term Review Date 30-Jan-2013 Last Archived ISR Date 06-Jun-201 1 Effectiveness Date 04-Oct-2010 Revised Closing Date 15-Jul-2015 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) To enable the Government of Nepal to increase access to essential health care services and their utilization by the underserved andthe poor. Has the Project Development Objective been changed since Board Approval of the Project? O Yes o No Component(s) Component Name Component Cost Health Service Delivery 114.42 Health Systems Strengthening 14.73 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory a Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory 0 o Overall Risk Rating Substantial Substantial U) Implementation Status Overview 0 0 Project implementation is progressing in a number of areas. The percentage of children receiving all basic vaccines has increased from 83 in 2006 to 86.6 percent in 2011 and o exceeded the target for the period (NDHS, 2006 and 2011). The percentage of births attended by skilled birth attendant has increased significantly to 36.0 in 2011 from 18.7 percent .0 in 2006 (NDHS 2006 and 2011). The percentage of health facilities with social audit has reached 40 percent against the end of project target of 25 percent (Service Tracking Survey, -0 2011). The percentage of children exclusively breastfed in the first 6 months increased significantly to 70 percent (NDHS 2006 and 2011). Tuberculosis case cure (success) rates 0. reached 90 percent exceeding the targets set at 89 percent; the percentage of MOHP budget allocated to essential health care services is maintained at 75 percent; about 3647 female community health volunteers have been deployed. As noted in the results matrix, end of project targets were already achieved for some of the indicators. The team will discuss with the government and partners during the Mid-Term Review in January 2013 to revisit the project targets to reflect the progress made so far. Page 1 of 7 @ The World Bank Report No: ISR5937 The second Joint Annual Review (JAR) of NHSP 2 was held for three days on January 16-18 to review progress made in the implementation of the program. The design, preparation and execution of this JAR have shown major improvement from the last JAR held in January 2011. The review commended the progress made and highlighted areas where performance is lagging including sanctioned positions for doctors and nurses that remain unfilled, and financial management. A business meeting was held at the end of the JAR to discuss key issues emerging from the JAR including expenditure priorities for the next year annual work plan and budget (APWB). The review concluded with specific and time bound 0 actions to address the issues identified. 0) o Locations 0 .U) No Location data has been entered 5 Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Skilled attendance at birth increased Percentage Value 28.80 36.00 35.00 Date 31-Dec-2009 31-Aug-201 1 15-Jul-2015 Comments 8.5% for the poorest income Data source: Nepal 25% for the poorest income quintile Demographic and Health quintile Survey (NDHS) 2011. A disaggregated data by wealth quintiles is expected in the final report of NDHS 2011. Fully immunized children increased Percentage Value 88.80 86.60 90.00 Date 31-Dec-2009 31-Aug-201 1 15-Jul-2015 Comments 82.6% for poorest income Data source: Nepal 88% for poorest income quintile Demographic and Health quintile Survey (NDHS) 2011. A disaggregated data by wealth quintiles is expected in the final report of NDHS 2011. >1 Mothers taking IFA during last pregnancy Percentage Value 81.30 73.00 87.00 o increased Date 31 -Dec-2009 14-Jul-2011 15-Jul-2015 Comments 70.5% for the poorest income Based on HMIS for the year 75% for the poorest income U, quintile 2067/68 (July15- July14- quintile o 2010/11). This figure will be .U) updated when the final results o of NDHS 2011 survey becomes available. Intermediate Results Indicators Page 2 of 7 The World Bank Report No: ISR5937 Indicator Name Core Unit of Measure Baseline Current End Target PHC facilities with essential drug stock outs >1 Percentage Value 67.00 50.00 week decreased Date 31-Dec-2009 31-Aug-201 1 15-Jul-2015 Comments Data not available yet. Data from Service Tracking Survey (STS) 2011 is being analyzed. o Additional SBAs deployed Number Value 0.00 900.00 500.00 Date 30-Jan-2012 15-Jul-2015 o Comments Source of data: Administrative A total of 5000 additional data from MOHP, NHTC/FHD. SBAs recruited & deployed over the life of the project. Actions in GAAP implemented Percentage Value 60.00 70.00 90.00 Date 31 -Dec-2009 30-Jan-2012 15-Jul-2015 Comments Data source: MOHP, PPICD. Social audits implemented in health facilities Percentage Value 0.00 45.00 25.00 Date 15-Jul-2010 30-Dec-2011 15-Jul-2015 Comments Data source: Service Tracking Survey 2011. In addition a pilot on community score card is ongoing. Health care finance strategy developed Yes/No Value No No Yes Date 12-May-2011 15-Jul-2015 Comments Analytical work on Fiscal space completed; Flagship course on Health System Strengthening and Sustainable Financing is underway. PHC centers providing Basic Emergency Percentage Value 23.00 21.00 70.00 0 Obstetric Services increased Date 31-Dec-2009 30-Dec-2011 15-Jul-2015 0 Comments Data source: Service Tracking Survey 2011. o Additional Female Community Health Number Value 0.00 3647.00 550.00 . Volunteers deployed Date 31 -Dec-2009 30-Jan-2012 15-Jul-2015 0 3 o L) Comments Data source: administrative A total of 5000 FCHVs -odata from MOHP, FHD. recruited, trained & deployed in over the life of the project. Health personnel receiving training x Number Value 0.00 900.00 550.00 Page 3 of 7 @ The World Bank Report No: ISR5937 Date 01-Jan-2010 30-Jan-2012 15-Jul-2015 Comments Source of data: Administrative A total of 5000 FCHVs data from MOHP, NHTC/FHD. recruited, trained & deployed >1 Comenrtsin over the life of the project. O C Health facilities constructed, renovated, and/or Number Value 0.00 527.00 a equipped Date 01-Jan-2010 30-Jan-2012 15-Jul-2015 0) Comments Data source: DUDBC. No target is set as this 0 The figure shows all facilities indicators is not part of the O) under construction Iresults matrix for the project. L) renovation. Children immunized Number Value 583819.00 569356.00 648476.00 Date 01 -Jan-201 0 30-Aug-201 1 15-Jul-2015 Comments This figure is based on the The figure is based on baseline coverage of 88.8% coverage of 86.6. It will be and using DHS 2006 for the updated when the final results proportion of children 12-23 of the NDHS survey become months; and CBS population available. projection (medium variant) for 2011 Pregnant women receiving antenatal care Number Value 746067.00 731490.00 864635.00 during a visit to a health provider Date 01-Jan-2010 14-Jul-2011 15-Jul-2015 Comments This figure is based on the The figure is based on baseline coverage of 87%. coverage of 97%. It will be Assuming pregnancy at 3% of updated when the final results the population and using CBS of the NDHS survey become population projection (medium available. variant) for 2011 Children receiving a dose of vitamin A Number Value 2624101.00 2828197.00 2875850.00 Date 01-Jan-2010 14-Jul-2011 15-Jul-2015 Comments This figure is based on the This figure is based on the baseline coverage of 90% baseline coverage of 90%. It 0 and using DHS 2006 for the will be updated when the final proportion of children 6-59 results of the NDHS survey months; and CBS population become available. 0) projection (medium variant) o for 2011 Modern contraceptive use among women Percentage Value 45.50 43.20 55.00 increased Date 31-Dec-2009 30-Aug-201 1 15-Jul-2015 Page 4 of 7 The World Bank Report No: ISR5937 Comments Data source: Nepal Demographic and Health Survey (NDHS) 2011 TB treatment success rate increased Percentage Value 85.00 90.00 89.00 oDate 31 -Dec-2009 14-Jul-2011 15-Jul-2015 Comments Source: HMIS for the fiscal year 2067/68 ( 2010/11). 0 0 Exclusively breastfed children in first 6 months Percentage Value 53.00 69.60 60.00 o increased Date 31-Dec-2007 30-Aug-201 1 15-Jul-2015 Comments Data source: Nepal Demographic and Health Survey (NDHS) 2011 Pregnant women attending at least one ante- Percentage Value 87.00 85.30 92.00 natal consultation increased Date 31 -Dec-2009 14-Jul-2011 15-Jul-2015 Comments Data source: HMIS for the fiscal year 2067/68 (2010/11). The figure will be updated when the final results of the NDHS survey become available. Diarrheal cases among under 5 children with Percentage Value 7.00 6.20 40.00 zinc and ORS increased Date 31-Dec-2009 30-Aug-201 1 15-Jul-2015 Comments Data source: initial results of Nepal Demographic and Health Survey (NDHS) 2011. It will be updated when the final results of the NDHS survey become available. Vitamin A coverage maintained in children 6-59 Percentage Value 90.00 97.00 90.00 months Date 31 -Dec-2009 14-Jul-2011 15-Jul-2015 Comments Data source: HMIS for the fiscal year 2067/68(2010/11). It will be updated when the U) final results of NDHS 2011 03 survey become available. 0 HIV prevention services for IDUs increased Percentage Value 30.00 50.00 - Date 31 -Dec-2009 14-Jul-2011 15-Jul-2015 Page 5 of 7 The World Bank Report No: ISR5937 Comments Prevention services coverage Data not available yet. Prevention services coverage for MSM and FSWs 31% and for MSM and FSWs 50% and 80% respectively at least 80% respectively Married women (15-49) with unmet need for Percentage Value 26.00 18.00 fDate 31-Dec-2009 14-Jul-2011 15-Jul-2015 Comments Data not available yet. It will be updated when the final results of the NDHS survey 0U become available. O Percent of MOHP budget allocated to EHCS Percentage Value 70.00 75.95 75.00 Date 31 -Dec-2009 14-Jul-2011 15-Jul-2015 Comments Data source: MOHP, annual implementation progress report for the fiscal year 2067/68 (2010/11) Data on Financial Performance (as of 07-Jun-2011) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P117417 IDA-47070 Effective 20-Apr-2010 18-Aug-2010 04-Oct-2010 15-Jul-2015 P117417 IDA-H5570 Effective 20-Apr-201 0 18-Aug-201 0 04-Oct-201 0 15-Jul-2015 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P117417 IDA-47070 Effective XDR 44.82 44.82 0.00 0.00 44.82 0.00 P117417 IDA-H5570 Effective XDR 38.28 38.28 0.00 13.69 24.59 36.00 Disbursement Graph 0 0 P ) Pae ,o The World Bank Report No: ISR5937 - Original ---- Formally Revised -- Actual 100 C) 04 0 0IIIII E ME 20- 0- 1CY N N N N N N N Key Decisions Regarding Implementation It was agreed that the Ministry and development partners will elaborate on the priorities and associated expenditures outlined in the draft Annual Work Plan and Budget (AWPB) by March 2012 during the first Joint Consultative Meeting (JCM) so that adequate attention is given to improving the performance of lagging indicators. Furthermore, it was agreed that MOHP will establish an audit committee to prevent recurrence of audit observations, put in place measures to limit the number of future audit observations and address future audit observations in a timely manner. The development partners will support the work of this committee through Technical Assistance and Technical Cooperation. Restructuring History There has been no restructuring to date. Related Projects There are no related projects. 0 U) 0 Page 7 of 7