The World Bank Implementation Status & Results Report Health and Gender Support Project for Cox’s Bazar district (P171648) Health and Gender Support Project for Cox’s Bazar district (P171648) SOUTH ASIA | Bangladesh | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 3 | ARCHIVED on 22-Sep-2021 | ISR48060 | Implementing Agencies: Ministry of Health and Family Welfare, Government of Bangladesh, The People’s Republic of Bangladesh Key Dates Key Project Dates Bank Approval Date: 31-Mar-2020 Effectiveness Date: 22-Jun-2020 Planned Mid Term Review Date: -- Actual Mid-Term Review Date: Original Closing Date: 30-Jun-2023 Revised Closing Date: 30-Jun-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) Improve the access to and utilization of HNP and GBV response services among the host and the displaced Rohingya population in Cox’s Bazar district. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Strengthening integrated HNP & GBV response services in all tiers of health care and in the DRP camps:(Cost $100.00 M) Component 2: Strengthening government system's capacity to deliver enhanced services in CXB:(Cost $45.00 M) Component 3: Stewardship, Management and Coordination:(Cost $5.00 M) Component 4: Contingent Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The Ministry of Health and Family Welfare (MOHFW) has contracted four United Nations agencies, including the International Organization for Migration (IOM), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and the United Nations Population Fund (UNFPA) to implement specific project activities:  UNFPA is supporting to strengthen integrated Sexual and Reproductive Health and Rights (SRHR) and gender-based violence (GBV) prevention and response services for the host at the community level and the Displaced Rohingya population (DRP) in Cox's Bazar district (CXB), set up of GBV Management Information System (MIS) in CXB, raise awareness about the health facilities to avail the different 9/22/2021 Page 1 of 8 The World Bank Implementation Status & Results Report Health and Gender Support Project for Cox’s Bazar district (P171648) levels of GBV response services, increase the knowledge of method mix for contraceptives including uptake of long-acting methods and is also responsible for the renovation and reconstruction of Union Health and Family Welfare Centers (UH&FWC).  WHO to build capacity with respect to: (i) the management of Non-Communicable Disease (NCDs) from community to district levels at all levels of care; (ii) screening and management of tuberculosis (TB) including the procurement of a mobile van for screening of TB at camps and facilities; (iii) management of health care waste at and beyond the health facilities; (iv) strengthen diagnostic laboratory facilities and safe blood transfusions; (v) preparedness and response to health emergencies from community to district levels; and (vi) strengthening coordination among different stakeholders.  UNICEF to improve the access to and utilization of health, nutrition and population at the level of upazila, scaling up of Special Care Newborn Unit (SCANU) in the district hospitals and upazila health complexes, setting up of Comprehensive Emergency obstetric care (CEmONC) at hard-to-reach upazilas e.g., Moheshkhali and Kutubdia and supporting immunization for host and DRP populations in CXB as well as the repair and renovation of upazila health complexes.  IOM to strengthen the integration of Health, Nutrition and Population (HNP) and GBV response services for the host community and DRP at the level of the community and revitalization of the Community Clinic Management Community at all upazillas. They will be responsible for the renovation and refurbishment of 100 Community Clinics and the repair of the District Sadar hospital including supply of the required Human Resources. The choice of these agencies is aligned with their comparative advantage in similar refugee and fragility related contexts. The total contract envelope for all four agencies amounts to US$119.5 million. This is in addition to US$30.5 million, which the MOHFW is utilizing mainly for supervision, monitoring, and coordination. With the signing of these four contracts, implementation of the Health and Gender Support Project has begun at full pace. As per the project’s development objective, the program is designed to improve the access to and utilization of HNP and GBV response services among the host and the DRP in CXB. The UN agencies frequently provide updates on the progress in the field to the Line Director (LD)’s office and have also submitted their first biannual progress reports. There were some challenges posed by the COVID-19 pandemic which slowed down implementation. Despite these challenges, there were some key achievements reported by the UN agencies:  IOM has completed the technical assessment of the community clinics for reconstruction and renovation; and the assessment of the district sadar hospital is ongoing. Recruitment of some qualified medical staff is still ongoing, but they have already successfully deployed Medical Officers, Nurses, Sonologist, Lab Technologist, Radiographers and Cleaners in the district hospital.  UNFPA has made substantial progress in strengthening SRHR services at the upazila health complexes through operational support; establishing midwifery-led care SRHR at selected UH&FWC; strengthening integrated SRHR and GBV services through Women Friendly Spaces (WFS); operationalization of WFS; procurement and supply of SRHR drugs and family planning commodities; providing technical assistance for SRH services at central and district levels.  UNICEF made significant progress in immunization services, providing vaccine and logistic support, and ensuring maternal, neonatal, child health and nutrition services.  WHO has completed the recruitment of the three consultants (Environmental Specialist, Social Development Specialist and Gender Specialist) who are critical for the implementation of project activities and a requirement as per the Bank’s Environmental and Social Commitment Plan and the Stakeholder Engagement Plan, with some delays in the recruitment process. However, the pace of implementation by WHO needs to be enhanced to strengthen screening, diagnostic and treatment capacity of TB and NCD service delivery. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Low Low Low Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Moderate Moderate Moderate Sustainability Fiduciary High High High Environment and Social Substantial Substantial Substantial 9/22/2021 Page 2 of 8 The World Bank Implementation Status & Results Report Health and Gender Support Project for Cox’s Bazar district (P171648) Stakeholders Substantial Substantial Substantial Other High High High Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improve the access to and utilization of HNP and GBV resonse services among the host and DRP in CXB IN01034042 ►Number of MOHFW facilities in CXB district providing 24/7 normal delivery (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 2.00 17.00 20.00 Date 31-Dec-2019 28-Jan-2021 31-Jul-2021 28-Feb-2023 Current data reported from UNFPA progress report as of July 2021 Comments: IN01034043 ►Number of children (0-11 months) in CXB district who have received three doses of pentavalent vaccines (disaggregated by gender, host and DRP) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 90,029.00 90,029.00 52,616.00 99,215.00 Date 31-Dec-2019 28-Jan-2021 28-Jan-2021 28-Feb-2023 Data currently reported for Jan - Jun 2021. Total - 52, 616 children Comments: Host - 35,221 (Male - 18,049, Female - 17,172) Camps - 17,395 (Male - 9,046, Female - 8,349) IN01034044 ►Number of women and girls utilizing GBV response services from the health facilities in CXB district (disaggregated by host and DRP) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5,106.00 5,106.00 19,345.00 15,500.00 Date 23-Sep-2019 28-Jan-2021 31-Jul-2021 28-Feb-2023 As of July 2021, Comments: 19,345 (Host - 4,180; DRP - 15,165) reported by UNFPA Intermediate Results Indicators by Components Strengthening integrated HNP& GBV response services in all tiers of health care & in the DRP camps 9/22/2021 Page 3 of 8 The World Bank Implementation Status & Results Report Health and Gender Support Project for Cox’s Bazar district (P171648) IN01034172 ►Number of cases received services from all community clinics in CXB district (disaggregated by gender) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 789,825.00 789,825.00 1,112,908.00 1,051,257.00 Date 31-Dec-2019 28-Jan-2021 31-Jul-2021 28-Feb-2023 As of July 2021, Comments: 1,112,908(Female Patient-783,563; Male Patient- 329,345) reported by UNFPA from DHIS2. IN01034174 ►Number of women and girls referred from one stop crisis cells to one stop crisis center (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 38.00 38.00 0.00 155.00 Date 23-Sep-2019 28-Jan-2021 31-Jul-2021 28-Feb-2023 Current data reported as of July 2021 Comments: IN01034176 ►Number of children 0-23 months who received IYCF counselling at UH&FWCs of CXB district (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2,101.00 2,101.00 231.00 34,000.00 Date 23-Sep-2019 28-Jan-2021 30-Jun-2021 28-Feb-2023 Data for Jan - Jun 2021 reported by UNICEF Comments: Current data - 231 IN01034177 ►Number of cases screened for hypertension at the CCs in CXB district (disaggregated by gender) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 33,120.00 Date 23-Sep-2019 28-Jan-2021 30-Jun-2021 28-Feb-2023 No data reported yet by WHO. Systems are being established to receive reports and monitor progress. Comments: IN01034178 ►Number of cases screened for type II diabetes mellitus at the CCs in CXB district (disaggregated By gender) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 22,080.00 Date 23-Sep-2019 28-Jan-2021 30-Jun-2021 28-Feb-2023 No data reported yet by WHO. Systems are being established to receive reports and monitor progress Comments: IN01034179 9/22/2021 Page 4 of 8 The World Bank Implementation Status & Results Report Health and Gender Support Project for Cox’s Bazar district (P171648) ►Number of women receiving emergency contraceptive pills from CCs, UH&FWCs, UzHCs and MCWC in CXB district (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2,207.00 2,207.00 1,636.00 5,300.00 Date 23-Sep-2019 28-Jan-2021 30-Jun-2021 28-Feb-2023 Progress as of July 2021 reported by UNFPA Comments: IN01034181 ►Number of cases in CXB screened for Tuberculosis (disaggregated by host and DRP) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 400,000.00 Date 23-Sep-2019 28-Jan-2021 30-Jun-2021 28-Feb-2023 No data reported yet by WHO. Systems are being established to receive reports and monitor progress Comments: IN01034183 ►Number of women and girls among the DRP in CXB receiving psych-social counselling services through WFS (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 9,103.00 9,103.00 3,112.00 22,050.00 Date 14-Nov-2019 28-Jan-2021 31-Jul-2021 30-Jun-2023 Progress reported as of July 2021 by UNFPA. The target will be achieved in this calendar year 1 (by Dec Comments: 2021) and the first 6 months of the government fiscal Year 2 (July- Dec 2021). IN01034185 ►Number of health facilities in CXB providing GBV response services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 3.00 8.00 221.00 Date 23-Sep-2019 28-Jan-2021 31-Jul-2021 27-Mar-2023 Progress reported by UNFPA as of July 2021. The target will be achieved in this calendar year 1 (by Dec Comments: 2021) and the first 6 months of the government fiscal Year 2 (July- Dec 2021). Strengthening government system's capacity to deliver enhanced services in Cox's Bazar IN01034175 ►Number of UH&FWCs in CXB district having no stock-out of 4 modern contraceptive methods in preceding three months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 0.00 Date 23-Sep-2019 28-Jan-2021 30-Jun-2021 30-Jun-2023 Comments: Progress reported by UNFPA as of July 2021. 100 percent achievement. 9/22/2021 Page 5 of 8 The World Bank Implementation Status & Results Report Health and Gender Support Project for Cox’s Bazar district (P171648) IN01034180 ►Number of facility staff who have received training for GBV response services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 45.00 0.00 353.00 Date 23-Sep-2019 28-Jan-2021 31-Jul-2021 28-Feb-2023 The training is planned to take place sometime between October – December 2021. It will be reflected in Comments: the next progress report which is expected to be submitted in January 2022. IN01034182 ►Number of CCs in CXB district with a functioning CSGs (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 110.00 Date 23-Sep-2019 28-Jan-2021 30-Jun-2021 28-Feb-2023 Due to COVID - 19, this was delayed. With the lifting of the restrictions, IOM has already started working Comments: on this. This will be reported by IOM in the next progress report which is expected in January 2022. IN01034184 ►Percentage of cases (complaints), received via the GRM (Grievance Redress Mechanism), that are resolved (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 13.00 70.00 Date 23-Sep-2019 28-Jan-2021 30-Jun-2021 28-Feb-2023 Reported by UNICEF for January - June 2021 Comments: Stewardship, Management and Coordination IN01034045 ►Number of quarterly coordination meetings held among MOHFW and MOWCA officials at the district level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 2.00 4.00 Date 23-Sep-2019 28-Jan-2021 30-Jun-2021 28-Feb-2023 Data reported by WHO. One in person meeting held in February 2021. Second meeting held through Comments: online platform. IN01034171 ►Number of six monthly supervision/monitoring visits by the officials of ministries and directorates at facilities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 9/22/2021 Page 6 of 8 The World Bank Implementation Status & Results Report Health and Gender Support Project for Cox’s Bazar district (P171648) Value 0.00 0.00 1.00 2.00 Date 23-Sep-2019 28-Jan-2021 30-Jun-2021 28-Feb-2023 Data reported by WHO. One visit conducted in February 2021. Comments: IN01034173 ►Number of quaterly supervision visits undertaken by district officials (CS, DDFP and DDWA) to review program implementation at the upazilla level and below (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 2.00 4.00 Date 23-Sep-2019 28-Jan-2021 30-Jun-2021 28-Feb-2023 Data reported by WHO. Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P171648 IDA-D5920 Effective USD 150.00 150.00 0.00 51.57 103.82 33% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P171648 IDA-D5920 Effective 31-Mar-2020 04-Jun-2020 22-Jun-2020 30-Jun-2023 30-Jun-2023 Cumulative Disbursements 9/22/2021 Page 7 of 8 The World Bank Implementation Status & Results Report Health and Gender Support Project for Cox’s Bazar district (P171648) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 9/22/2021 Page 8 of 8