The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) Health and Nutrition Services Access Project (P166165) EAST ASIA AND PACIFIC | Lao People's Democratic Republic | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 1 | ARCHIVED on 13-Jul-2020 | ISR42168 | Implementing Agencies: Lao People's Democratic Republic, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 12-Mar-2020 Effectiveness Date: -- Planned Mid Term Review Date: -- Actual Mid-Term Review Date: Original Closing Date: 31-Dec-2025 Revised Closing Date: 31-Dec-2025 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To improve access to quality health and nutrition services in targeted areas of Lao PDR. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Integrating Service Delivery Performance with National Health Insurance Payments:(Cost $12.20 M) Component 2: Service Delivery and Nutrition Convergence:(Cost $17.80 M) Component 3: Adaptive Learning and Project Management:(Cost $6.00 M) Component 4: Contingent Emergency Response Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO -- Satisfactory Overall Implementation Progress (IP) -- Satisfactory Overall Risk Rating -- Substantial Implementation Status and Key Decisions The Health and Nutrition Services Access (HANSA) project was approved by the board on March 12, 2020. The financing agreements (IDA Credit 65570-LA and IDFHD-Grant TF-B2043) were signed on April 28, 2020. The National Project Coordination Office under the Department of Planning and Cooperation of the Ministry of Health has been making satisfactory progress in preparing for the project effectiveness scheduled by July 27, 2020. 7/13/2020 Page 1 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial -- Substantial Macroeconomic Substantial -- Substantial Sector Strategies and Policies Substantial -- Substantial Technical Design of Project or Program High -- High Institutional Capacity for Implementation and High -- High Sustainability Fiduciary Substantial -- Substantial Environment and Social Moderate -- Moderate Stakeholders Substantial -- Substantial Other -- -- Moderate Overall Substantial -- Substantial Results PDO Indicators by Objectives / Outcomes Improved access to quality healthcare services IN00854325 ►Number of deliveries attended by a skilled birth attendant (DLI I) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 84,300.00 -- 84,300.00 119,830.00 Date 31-May-2020 -- 31-May-2020 31-Dec-2024 Access indicator from National Assembly Indicator list. Baseline at preparation is based on DHIS2 data covering the period June 1, 2018-May 30,2019, for 18 provinces combined. The ISR updated the baseline Comments: based on information provided by National Project Coordination Office which covering period from June 2019-May 2020. End target at 9% increase over baseline. IN00854328 ►Number of health centers scoring above 60% on a standard quality assessment system (DLI A) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 600.00 Date 31-May-2019 -- 31-May-2020 31-Dec-2024 7/13/2020 Page 2 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) Quality measure through the Quality Performance Scorecard (QPS). Baseline is from HGNDP DLI6 (supervisory checklist), covering the period June 1 2018-May 30, 2019. Data is only for 14 provinces Comments: where HGNDP is implemented. End target is 60% increase over baseline, QPS will be rolled out in phases starting from 4 nutrition convergence districts to eventually nationwide at the end of project. Improved access to quality nutrition services IN00854327 ►Percentage of children under 2 years of age whose growth is adequately monitored as per national guidelines in the twelve nutrition convergence districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 36.00 -- 36.00 80.00 Date 31-May-2020 -- 31-May-2020 31-Dec-2024 Comments: Nutrition convergence indicator IN00854329 ►Percentage of pregnant women who receive 4 Antenatal Care contacts in the twelve nutrition convergence districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 52.00 -- 52.00 62.00 Date 31-May-2019 -- 31-May-2020 31-Dec-2024 Increasing the utilization of primary care and improving efficiency of public spending IN00854326 ►Share of outpatient cases delivered at the primary healthcare facilities among the total outpatient services delivered in the country (including hospitals) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 42.00 -- 42.00 50.00 Date 31-May-2020 -- 31-May-2020 31-Dec-2024 Indicator of efficiency, primary care performance. Denominator defined as number of new OPD cases for Comments: health centers, district hospitals (34%) and central hospitals (7%). Data from DHIS2, baseline period June 1, 2018-May 31, 2019. Data to be disaggregated by gender. Overall Comments PDO No updated value is available for this first ISR Intermediate Results Indicators by Components Integrating Service Delivery Performance with National Health Insurance Payments IN00854330 ►Number of health centers that have had regular (twice per year) quality assessment visits and verified (DLI A) (Number, Custom) 7/13/2020 Page 3 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 800.00 Date 31-May-2020 -- 30-Jun-2020 31-Dec-2024 QPS is expected to first be implemented in 4 nutrition convergence provinces, to be scaled up nationwide Comments: by the end of project. So baseline is zero. IN00854333 ►Number of health centers that received their payments within the prescribed timeline in the latest round of quality assessments (DLI B) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 800.00 Date 31-May-2020 -- 30-Jun-2020 31-Dec-2024 Comments: The 'prescribed' timeline for funds transfer will be defined in the QPS manual. Service Delivery and Nutrition Convergence IN00854331 ►Number of health centers which have at least 85% of 30 days' stock of agreed list of drugs and commodities (DLI C) (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 800.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 Comments: DLI. IN00854334 ►Number of health centers assessed and certified in financial management (DLI E) (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 800.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 Comments: DLI IN00854336 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 1,200,000.00 Date 31-May-2020 -- 30-Jun-2020 31-Dec-2024 IN00854337 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) 7/13/2020 Page 4 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 960,000.00 IN00854338 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 100,000.00 -- 100,000.00 200,000.00 Date 31-May-2020 -- 30-Jun-2020 31-Dec-2024 IN00854339 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 400,000.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 IN00854340 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 400,000.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 IN00854341 ►Number of villages in nutrition convergence districts wihch have conducted at least 10 monthly SBCC sessions in the last 12 months (DLI F) (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 269.00 -- 269.00 800.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 The monthly SBCSS sessions follow a prescribed set of activities including growth monitoring and Comments: promotion IN00854342 ►Number of villages in Zones 2 and 3 in nutrition convergence districts in which integrated outreach sessions are conducted (DLI H) (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 -- 50.00 450.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 Integrated outreach services comprise 5 services: ANC, FP, immunization, growth monitoring and Vt.A. Comments: IN00854343 ►Number of notified TB cases in all forms (per 100,000) (DLI J) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 91.00 -- 91.00 81.00 7/13/2020 Page 5 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 DLI J. "All forms" means bacteriologically confirmed and clinically diagnosed new and relapse cases. Comments: Current notified rate is 91%, this is expected to increase by some but once treatment starts the number is expected to go down. Hence end target is 81%. IN00854344 ►Percentage of women in nutrition convergence districts receiving at least 90 iron folic acid tablets at last pregnancy (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 70.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 IN00854345 ►Percentage of children 6-59 months receiving vitamin A supplementation within the past 6 months in the twelve nutrition convergence districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 70.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 IN00854346 ►Percentage of Children 0-59 months in the twelve nutrition convergence districts exclusively breastfed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 56.20 -- 56.20 62.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 IN00854347 ►Percentage Average score on the quality and performance scorecard for all health centers in the twelve nutrition convergence districts (DLI A) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 60.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 IN00854348 ►Percentage increase over baseline of children who have received DPT3 in nutrition convergence districts (DLI I) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 10.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 Adaptive learning and project management IN00854332 ►Number of health centers that undertake MCH tracker or event capture in DHIS2 (DLI F) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 7/13/2020 Page 6 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) Value 158.00 -- 158.00 600.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 IN00854335 ►Number of citizens providing feedback on services provided at primary health care level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 25,000.00 Date 31-May-2019 -- 30-Jun-2020 31-Dec-2024 This indicator will be captured through patient exit surveys to be conducted as part of QPS. To be Comments: disaggregated by gender. Performance-Based Conditions IN00854349 ►PBC 1 Quality performance and service readiness measurement conducted regularly at health center level (DLI A) (Text, Process, 1,500,000.00, 0.00%) (Year 4) June 1, Baseline Actual (Previous) Actual (Current) 2023 - May 31, 2024 1. Quality and Performance Scorecard rolled out to at least eighty percent (80%) of all health centers nationwide; ninety percent (90%) of health centers have had regular (two (2) times/year/health center) quality assessment and random independent third-party verification;2. Value TBC -- 0.00 Thirty (30) percentage points increase in the average score from the baseline score of health centers in the twelve (12) nutrition convergence districts on QPS assessment;3. Reduction by thirty percent (30%) of health centers whose verification scores from previous year 7/13/2020 Page 7 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) are more than ten percent (10%) lower than assessment scores.DLI value: 0 (added in AF) Date -- -- 08-Jun-2020 -- IN00854350 ►PBC 2 Number of patients who pay out of pocket payment for “Free” Maternal and Child Services reduced (DLI B). (Text, Intermediate Outcome, 700,000.00, 0.00%) (Year 4) June 1, Baseline Actual (Previous) Actual (Current) 2023 - May 31, 2024 1. Ninety percent (90%) reduction in the number of health center receiving their payments after the prescribed timeline; Value TBD -- 0.00 2. Eighty percent (80%) decrease from baseline in the number of women not receiving free MCH fully covered by NHI. Date -- -- 08-Jun-2020 -- IN00854351 ►PBC 3 Availability of essential drugs and supplies at health center level improved (DLI C) (Text, Output, 1,650,000.00, 0.00%) (Year 4) June 1, Baseline Actual (Previous) Actual (Current) 2023 - May 31, 2024 1. At least eighty five percent (85%) of all health centers in all provinces have eighty five percent (85%) of thirty (30) Value 0.00 -- 0.00 days’ supply of essential drugs and supplies according to the agreed list. DLI value: 0 (added in AF) Date -- -- 30-Jun-2020 -- 7/13/2020 Page 8 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) IN00854352 ►PBC 4 Number of provinces in which the number of health centers without a clinical health worker, as reported in the DHIS2, has been reduced. l (DLI D). (Text, Intermediate Outcome, 800,000.00, 0.00%) (Year 4) June 1, Baseline Actual (Previous) Actual (Current) 2023 - May 31, 2024 1. At least sixty percent (60%) reduction from baseline of number of health centers, or Value TBD -- 0.00 at least eighty percent (80%) of all health centers in all provinces have a clinical health worker, nationwide. Date -- -- 08-Jun-2020 -- IN00854353 ►PBC 5 Improvement of financial management capacity at health center level (DLI E) (Text, Intermediate Outcome, 1,000,000.00, 0.00%) (Year 4) June 1, Baseline Actual (Previous) Actual (Current) 2023 - May 31, 2024 1. At least eighty percent (80%) of all health centers nationwide are Value 0.00 -- 0.00 certified in FM. DLI value: 0 (added in AF) Date -- -- 30-Jun-2020 -- IN00854354 ►PBC 6 Increased coverage and correctness of event capture reports for selected services (DLI F) (Text, Process, 1,000,000.00, 0.00%) (Year 4) June 1, Baseline Actual (Previous) Actual (Current) 2023 - May 31, 2024 Value 0.00 -- 0.00 1. At least ninety five percent (95%) of total health facilities in country apply event capture; 2. Eighty percent (80%) reduction in variance of data reported 7/13/2020 Page 9 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) through event capture and monthly aggregate data from the baseline. DLI value: 0 (added in AF) Date -- -- 30-Jun-2020 -- IN00854355 ►PBC 7 Implementation of Social and Behavioral Change Communication and Growth Monitoring and Promotion activities at village-level (DLI G) (Text, Output, 1,561,500.00, 0.00%) (Year 4) June 1, Baseline Actual (Previous) Actual (Current) 2023 - May 31, 2024 1. Up to eight hundred eighty-one (881) villages, in twelve (12) nutrition convergence districts have conducted at least ten (10) monthly Value TBD -- 0.00 SBCC sessions in the past twelve (12) months with a prescribed set of activities including growth monitoring and promotion and have reported these in DHIS2. Date -- -- 08-Jun-2020 -- IN00854356 ►PBC 8 Number of villages in Zones 2 and 3 in nutrition convergence districts in which integrated outreach sessions are conducted (DLI H) (Text, Output, 900,000.00, 0.00%) (Year 4) June 1, Baseline Actual (Previous) Actual (Current) 2023 - May 31, 2024 1. Up to seven hundred (700) villages in Zone 2 and Zone 3 in nutrition convergence provinces conducted Value 50.00 -- 50.00 at least three (3) quarterly integrated outreach sessions in a year. DLI value: 0 (added in AF) 7/13/2020 Page 10 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) Date -- -- 30-Jun-2020 -- IN00854357 ►PBC 9 Number of Immunization Target Districts which have increased the Pentavalent 3 and deliveries with Skilled Birth Attendant (DLI I) (Text, Outcome, 1,800,000.00, 0.00%) (Year 4) June 1, Baseline Actual (Previous) Actual (Current) 2023 - May 31, 2024 1. Number of districts among the fifty (50) Immunization Target Districts which have achieved an increase of twelve (12) percentage points in the number of children less than twelve (<12) months covered by DPT- HepB-Hib over the baseline or maintained a coverage with DPT- HepB-Hib of ninety- five percent (95%) or more. Value TBD -- 0.00 2. Number of districts in fifty (50) Immunization Target Districts which have received an increase of nine (9) percentage points the number of women delivered by Skilled Birth Attendant over the baseline or reached or maintained a coverage with Skilled Birth Attendant of ninety percent (90%) or more. Date -- -- 08-Jun-2020 -- IN00854358 ►PBC 10 Number of notified TB cases of all forms (i.e. bacteriologically confirmed and clinically diagnosed new and relapse cases) (DLI J). (Text, Process, 3,600,000.00, 0.00%) (Year 4) June 1, Baseline Actual (Previous) Actual (Current) 2023 - May 31, 2024 7/13/2020 Page 11 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) 1. Provinces that achieved the targeted number of notified TB cases of all forms; 2. Provinces which have reached Value TBD -- 0.00 or maintained one hundred percent (100%) GeneXpert coverage. DLI value: 0 (added in AF) Date -- -- 08-Jun-2020 -- IN00854359 ►PBC 11 Increased coverage of a) HIV testing among key populations (female service women [FSW]) and men having sex with men [MSM]); b) and HIV treatment among people living with HIV. (DLI K) (Text, Outcome, 2,900,000.00, 0.00%) (Year 4) June 1, Baseline Actual (Previous) Actual (Current) 2023 - May 31, 2024 1. Two (2) percentage points increase over the previous year in HIV testing coverage of estimated FSW during the past twelve (12) months. 2. Ten (10) percentage points increase over the previous year in HIV testing coverage of estimated MSM Value 269.00 -- 269.00 during the past twelve (12) months. 3. Five (5) percentage points increase over the previous year in number of HIV positive cases receiving antiretroviral treatment nationwide. DLI value: 0 (added in AF) Date -- -- 30-Jun-2020 -- 7/13/2020 Page 12 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) IN00854360 ►PBC 12 Increase in national readiness for health security in responding to pandemics and health emergency at international boundaries (airports and ground crossings) (DLI L) (Text, Output, 389,500.00, 0.00%) (Year 4) June 1, Baseline Actual (Previous) Actual (Current) 2023 - May 31, 2024 1. Training activities as per national SOPs for four (4) additional formal ground crossings with less than one hundred fifty (<150,000) travelers per year. 2. Simulation exercises held at two (2) international Value TBD -- 0.00 airports and two (2) additional formal ground crossings with more than one hundred fifty (>150,000) travelers per year. .. DLI value: 0 (added in AF) Date -- -- 08-Jun-2020 -- Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Not P166165 IDA-65570 USD 23.00 23.00 0.00 0.00 23.00 0% Effective Not P166165 TF-B2043 USD 0.30 0.30 0.00 0.00 0.30 0% Effective Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date Not P166165 IDA-65570 12-Mar-2020 28-Apr-2020 -- 31-Dec-2025 31-Dec-2025 Effective Not P166165 TF-B2043 12-Mar-2020 -- -- 30-Jun-2023 30-Jun-2023 Effective Cumulative Disbursements 7/13/2020 Page 13 of 14 The World Bank Implementation Status & Results Report Health and Nutrition Services Access Project (P166165) 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. 7/13/2020 Page 14 of 14