The World Bank Report No: ISR10192 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: 8 Status: ARCHIVED Archive Date: 10-May-2013 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 30-Oct-2012 Last Archived ISR Date 22-Sep-2012 Effectiveness Date 15-Dec-2009 Revised Closing Date 31-Jan-2015 Actual Mid Term Review Date 26-Feb-2013 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 Moderately Satisfactory Overall Risk Rating Page 1 of 6 The World Bank Report No: ISR10192 Implementation Status Overview Project was approved by the Board on February 17, 2009 and became effective in December 15, 2009. The project was restructured on June 21, 2011. A Mid-Term Review (MTR) was conducted on February 2013, in close coordination with the Inter-American Development Bank (IADB), to assess the project status and identify strategies to improve its implementation. The current project implementation status is satisfactory. As of April 2013, the project has disbursed US$5.6 million (38% of loan proceeds). Public Disclosure Copy The Project effectively contributed to improve families’ access to maternal and child health home assistance, through the consolidation of the Strategy for Promotion of Healthy Practices and Environments (EPPES). Also, the Promotion Strategy for Identification (DIA) has contributed to facilitate the SIS’ identification and affiliation processes. On the other hand, the project has strengthened the regional management capabilities on Maternal and Child Health (MCH) through specialized training in neonatal and obstetric competencies for health professionals and managerial capacities for the Health Regional Directorates (DIRESA). Finally, civil works in 29 health facilities were concluded and 41basic neonatal and obstetric health facilities were provided with clinic and office equipment. Specific recommendations coming from the MTR will be implemented to ensure achievement of project goals. Locations Country First Administrative Division Location Planned Actual Peru Not Entered Departamento de Ucayali Peru Not Entered Departamento de Huánuco Peru Not Entered Departamento de Cajamarca Peru Not Entered Departamento de Amazonas Peru Not Entered Departamento de Puno Peru Not Entered Departamento de Huancavelica Peru Not Entered Departamento de Cusco Peru Not Entered Departamento de Ayacucho Peru Not Entered Departamento de Apurímac Results Project Development Objective Indicators Public Disclosure Copy Indicator Name Core Unit of Measure Baseline Current End Target Increase the proportion of pregnant women of Percentage Value 20.00 67.50 45.00 the nine regions with at least 1 prenatal control Date 30-Dec-2005 09-Dec-2011 30-Dec-2013 during the first trismester of pregnancy from Comments Target achieved. Percentage 20% (2005) to 45% (2013) has increased substantially. Page 2 of 6 The World Bank Report No: ISR10192 Increase the proportion of institutional Percentage Value 44.00 67.20 78.00 deliveries in rural areas of the nine selected Date 30-Dec-2005 28-Feb-2012 30-Dec-2013 Regions from 44% (2005) to 78% (2013) Comments Progress on this indicator is Public Disclosure Copy very positive trend and is on track to be achieved in 2013. Reduce the prevalence of anemia among Percentage Value 69.50 63.00 60.00 children under age 3 in the nine regions from Date 30-Dec-2005 24-Feb-2012 30-Dec-2013 69.5% (2005) to 60% (2013) Comments This indicator is on track to be achieved in 2013. Increase from 64% to 80% the share of Percentage Value 64.00 78.60 80.00 children in the nine selected regions who are Date 30-Dec-2005 28-Feb-2011 30-Dec-2013 exclusively breastfed until 6 months of age Comments Indicator on track to be achieved. Reduce the prevalence of anemia among Percentage Value 41.50 35.00 pregnant women in the nine Regions from Date 30-Dec-2005 30-Dec-2013 41.5% (2005) to 35% (2013). Comments Information related to this indicator will be produced by June 2013. Reduce the hospital lethality rate among Percentage Value 9.50 5.00 neonates in the nine selected Regions from Date 30-Dec-2005 30-Dec-2013 9.5% (2005) to 5% (2013). Comments Information related to this indicator will be produced by June 2013. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Component 1: % of SIS affiliated children who Percentage Value 34.00 74.60 66.00 received growth and development controls Date 30-Dec-2005 24-Feb-2012 30-Dec-2013 (CRED) according to their age Public Disclosure Copy Comments Indicator achieved and surpassed. Component 2: % of SIS affiliated rural pregnant Percentage Value 37.00 29.90 80.00 women with laboratory tests on hemoglobin, Date 30-Dec-2005 24-Feb-2012 30-Dec-2013 urine and syphilis Comments This indicator has presented low performance due delays in labs construction. Component 2: % of pregnant women under SIS Percentage Value 37.00 59.80 80.00 that receive iron and folic acid supplements Date 30-Dec-2005 24-Feb-2012 30-Dec-2013 Page 3 of 6 The World Bank Report No: ISR10192 Comments Progress on this indicator has been slow The Project is undertaking significant efforts to improve supply distribution Public Disclosure Copy in particular. Component 2: % of cesareans in SIS affiliated Percentage Value 3.00 6.60 5.00 pregnant rural women Date 30-Dec-2005 28-Feb-2012 30-Dec-2013 Comments This indicator has been achieved and surpassed. Component 2: % of health facilities with Percentage Value 0.00 19.00 90.00 improvement in infrastructure (minor Date 30-Dec-2005 24-Feb-2012 30-Dec-2013 construction and / new equipment) Comments Project has initiated massive infrastructure works in all regions, and some of them are already initiating its functioning. Component 2: % of women satisfied with the Percentage Value 1.00 74.40 25.00 services in selected facilities by confidence Date 30-Dec-2005 24-Feb-2012 30-Dec-2013 index Comments Target Achieved and surpassed Component 3: % of SIS affiliated households Percentage Value 67.30 70.00 25.00 that make out-of-pocket expenditures in Date 30-Dec-2005 24-Feb-2012 30-Dec-2013 medicines Comments An evaluation of households out-of-pocket expenditures on medicine was undertook in 2012. However, no progress has been identified so far. Component 3: % of references among SIS- Percentage Value 0.00 5.00 affiliated women (during pregnancy and Date 30-Dec-2005 30-Dec-2013 puerperium) and neonates. Comments Information related to this Public Disclosure Copy indicator will be produced by June 2013. Component 3: Number of accredited health Percentage Value 80.00 169.00 establishements by type of resolution. Date 30-Dec-2005 30-Dec-2013 Comments Information related to this indicator will be produced by June 2013. Component 3: Number of Management Number Value 0.00 Agreements in place. Date Page 4 of 6 The World Bank Report No: ISR10192 Comments Information related to this indicator will be produced by June 2013. Public Disclosure Copy Data on Financial Performance (as of 30-Jan-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P095563 IBRD-76430 Effective 17-Feb-2009 16-Nov-2009 15-Dec-2009 31-Jan-2015 31-Jan-2015 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P095563 IBRD-76430 Effective USD 15.00 15.00 0.00 5.65 9.35 38.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation Agreements during the MTR include: (i) updating project goals with geographical disaggregation, given its extension; (ii) accelerating loan disbursements; and (iii) strengthening the Project‘s monitoring and evaluation system. Restructuring History There has been no restructuring to date. Page 5 of 6 The World Bank Report No: ISR10192 Related Projects There are no related projects. 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