The World Bank Implementation Status & Results Report South Sudan Provision of Essential Health Services Project (P168926) South Sudan Provision of Essential Health Services Project (P168926) AFRICA EAST | South Sudan | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2019 | Seq No: 4 | ARCHIVED on 19-Nov-2020 | ISR44080 | Implementing Agencies: International Committee of the Red Cross, International Committee of the Red Cross, UNICEF, UNICEF Key Dates Key Project Dates Bank Approval Date: 27-Feb-2019 Effectiveness Date: 11-Mar-2019 Planned Mid Term Review Date: 15-Dec-2020 Actual Mid-Term Review Date: Original Closing Date: 31-Dec-2021 Revised Closing Date: 31-Dec-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective is to increase access to an essential package of health services in the Republic of South Sudan, with a particular focus on the former states of Upper Nile and Jonglei. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Delivery of Essential Health Services:(Cost $93.00 M) Monitoring, Evaluation and Learning:(Cost $4.00 M) Emergency Preparedness and Response:(Cost $3.00 M) Repayment of Project Preparation Advances:(Cost $5.40 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating High High Implementation Status and Key Decisions Based on results reported to date, eight of nine (89%) Project Development Objective indicators, and eight of 11 (73%) intermediate results indicators are on track to be achieved or exceeded by the project’s closing date. The Contingent Emergency Response Component (CERC) in the amount of US$5 million was activated on April 6, 2020 to address South Sudan’s COVID-19 emergency response needs. The CERC supports the National COVID-19 Preparedness Response Plan and activities are being implemented in close coordination with other development partners and the COVID-19 National Task Force chaired by the Ministry of Health. A proposed Additional Financing (AF) is under preparation to replenish funds allocated to the CERC. The proposed AF is expected to be submitted for approval by the World Bank’s Board of Executive Directors in December 2020. 11/19/2020 Page 1 of 9 The World Bank Implementation Status & Results Report South Sudan Provision of Essential Health Services Project (P168926) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic High High High Sector Strategies and Policies High High High Technical Design of Project or Program High High High Institutional Capacity for Implementation and High High High Sustainability Fiduciary High High High Environment and Social High High High Stakeholders High High High Other -- -- -- Overall High High High Results PDO Indicators by Objectives / Outcomes Increase the utilization of an essential package of health services IN00912406 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,027,039.00 1,844,090.00 1,400,000.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 People who have received essential health, nutrition, and population (HNP) services ICRC: 561,145 UNICEF: 1,282,945 People who have received essential health, nutrition, and population (HNP) services - Female ICRC: 120,610 UNICEF: 380,220 Comments: Number of children immunized ICRC: 169,335 UNICEF: 643,414 Number of deliveries attended by skilled health personnel ICRC: 7,295 UNICEF: 11,072 11/19/2020 Page 2 of 9 The World Bank Implementation Status & Results Report South Sudan Provision of Essential Health Services Project (P168926) IN00912409 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 500,830.00 812,749.00 800,000.00 IN00912411 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 110,657.00 258,037.00 75,000.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 IN00912412 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 164,888.00 250,446.00 200,000.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 IN00912413 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11,367.00 18,367.00 25,000.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 IN00912414 ►Number of curative consultations provided for under 5 children (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 703,263.00 969,374.00 1,000,000.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 UNICEF: 855,754 ICRC: 113,620 Comments: Total number of consultations provided to children less than 5 years of age Increase the quality of an essential package of health services IN00912407 ►Number of health facilities with essential medicines available (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 176.00 155.00 200.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 Comments: UNICEF: 134 11/19/2020 Page 3 of 9 The World Bank Implementation Status & Results Report South Sudan Provision of Essential Health Services Project (P168926) ICRC: 21 Tracer drug availability was impacted by transport and movement restrictions put in place to control the COVID-19 pandemic. Availability of 5 tracer drugs during supervision visits (oral paracetamol, oral amoxicillin, oral rehydration solution, oral artesunate-amodiaquine) IN00912408 ►Number of health facilities providing at least 75 percent of the essential package of health services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 169.00 88.00 200.00 Date 01-Jan-2019 12-May-2020 31-Aug-2020 31-Jan-2021 Rollout of the essential package of health services has been delayed by gaps in staff, equipment, and pharmaceuticals. This is further complicated by capacity gaps, remote facilities, and very limited infrastructure in South Sudan's environment. Total 88 Comments: ICRC: 18 UNICEF: 70 Essential package of services is defined in Annex 6 of the PAD IN00912410 ►Proportion of disease outbreaks detected and responded to within 72 hours of confirmation (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 15.00 100.00 100.00 50.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 ICRC: 100% UNICEF: 100% Comments: Proportion of disease outbreaks detected and responded to within 72 hours of confirmation Intermediate Results Indicators by Components Delivery of a package of essential health services IN00912415 ►Number of children aged 6-59 months who received vitamin A supplementation (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 89,385.00 131,454.00 250,000.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 Number of children aged 6-59 months who received vitamin A supplementation Comments: IN00912417 11/19/2020 Page 4 of 9 The World Bank Implementation Status & Results Report South Sudan Provision of Essential Health Services Project (P168926) ►Number of children less than 1 year who received measles vaccination (first dose) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 40,224.00 81,080.00 75,000.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 ICRC: 9,293 UNICEF: 71,787 Comments: Number of children less than 1 year who received measles vaccination (first dose) IN00912420 ►Number of pregnant women receiving ANC four visits (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 22,661.00 43,704.00 40,000.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 ICRC: 11,405 UNICEF: 32,299 Comments: Number of pregnant women receiving ANC four visits IN00912422 ►Number of newborns receiving postnatal visit within two days of childbirth (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6,118.00 12,070.00 17,000.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 Comments: Number of newborns receiving postnatal visit within two days of childbirth IN00912423 ►Proportion of gender-based survivors presenting at health facilities provided with clinical management of rape services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 99.40 98.00 100.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 ICRC: 95% UNICEF: 100% Comments: Number of gender-based survivors provided with clinical management of rape services IN00912424 ►Number of health care workers trained in-service (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,611.00 6,427.00 400.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 11/19/2020 Page 5 of 9 The World Bank Implementation Status & Results Report South Sudan Provision of Essential Health Services Project (P168926) ICRC: 1,373 UNICEF:5,054 Comments: Number of health care workers trained in-service in topics such as safe motherhood, integrated management of childhood illnesses (IMNCI), effective vaccine management and immunization in practice, and malaria testing and treatment IN00912425 ►Number of community health workers trained to implement integrated community case management (iCCM) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,436.00 1,843.00 200.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 Number of community health workers trained to implement integrated community case management Comments: (iCCM) Monitoring, Evaluation and Learning IN00912416 ►Proportion of functional health facilities submitting standardized HMIS monthly reports into the DHIS2 or HMIS equivalent system within one month of the reporting month (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 84.00 93.00 75.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 ICRC: 100% UNICEF: 92% Comments: Proportion of functional health facilities submitting standardized HMIS monthly reports into the DHIS2 or HMIS equivalent system within one month of the reporting month IN00912418 ►Proportion of health facilities with structured supervision visit within a month (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 40.00 45.00 60.00 70.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 ICRC: 78% UNICEF: 58% (on average) Comments: Proportion of health facilities with structured supervision visit using a standardized Supervisory Tool/Checklist to assess and monitor quality of care within a month IN00912421 ►Number of monitoring reports submitted (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 1.00 0.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 11/19/2020 Page 6 of 9 The World Bank Implementation Status & Results Report South Sudan Provision of Essential Health Services Project (P168926) Number of monitoring reports submitted is behind expectations. There are a number of reasons for this including security and COVID-19 related delays. The WB team has been working with UNICEF to improve the timeliness of monitoring reports. Number of monitoring reports (including both health facility and LQAS) submitted in areas where external monitoring will be conducted. The performance monitoring methodology and reports will include citizen Comments: engagement mechanisms such as exit interviews conducted during data verification visits. The questionnaires will be customized to capture key domains on satisfaction and perceived quality of care, in order to capture community feedback on service delivery. Results from the quarterly reports will be used to engage with citizens on key elements related to improving service delivery in targeted communities. Emergency Preparedness and Response IN00912419 ►Number of state-level Rapid Response Teams trained on investigation of alerts and immediate outbreak response (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 31-Dec-2018 12-May-2020 31-Aug-2020 31-Jan-2021 RRT trainings were delayed; as of early 2020, these were planned for Q1 and Q2 2020. The training of RRTs could not be conducted during that period due to travel restrictions related to the COVID-19 outbreak in South Sudan. WHO, as per their mandate, has taken the lead in training State RRTs on the COVID-19 response. UNICEF is now coordinating with WHO and the MOH to plan for the training on emergency preparedness and response to take place in the next reporting period as early as feasible, Comments: based on availability of state RRTs. Number of state-level rapid response teams, in particular health and WASH personnel, on investigation of alerts and immediate outbreak response, as well as requirements for IPC associated with the preparation of disinfectants of different concentrations, excreta disposal and monitoring of water quality. Overall Comments IR Based on combined results from UNICEF and ICRC, eight of nine (89%) PDO indicators are on track to be achieved or exceeded by the project’s closing date. The number of health facilities providing at least 75% of the essential package of health services is the only PDO indicator below expected achievement, at 88 total facilities, compared to an end of project target of 200. Eight of eleven (73%) intermediate results indicators (IRIs) are on track to be met or exceeded and six IRIs (55%) have already been met or exceeded. The number of children receiving vitamin A supplementation is currently 131,545, compared to expected achievement of 157,895 and an end target of 250,000. Current achievement is 83% of expected achievement and may increase when dry season vitamin A supplementation campaigns are possible, if such campaigns are possible given COVID-19 travel restrictions. Achievement on number of monitoring reports submitted is currently one, compared to an end of project target of six. Monitoring reports have been delayed for a number of reasons including security challenges and COVID-19 related restrictions. The WB team is working with UNICEF to address monitoring report delays. The number of State level rapid response teams trained is also currently at zero achievement, due to COVID-19 related delays and because COVID-19 response trainings are being conducted by UNICEF. [1] UNICEF data are provisional through July, 2020 Performance-Based Conditions Data on Financial Performance 11/19/2020 Page 7 of 9 The World Bank Implementation Status & Results Report South Sudan Provision of Essential Health Services Project (P168926) Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P168926 IDA-D4270 Effective USD 73.40 73.40 0.00 71.41 1.15 98% P168926 IDA-D4280 Effective USD 32.00 32.00 0.00 19.89 12.24 62% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P168926 IDA-D4270 Effective 27-Feb-2019 28-Feb-2019 11-Mar-2019 31-Dec-2021 31-Dec-2021 P168926 IDA-D4280 Effective 27-Feb-2019 01-Mar-2019 19-Mar-2019 31-Dec-2021 31-Dec-2021 Cumulative Disbursements PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC 11/19/2020 Page 8 of 9 The World Bank Implementation Status & Results Report South Sudan Provision of Essential Health Services Project (P168926) Restructuring History There has been no restructuring to date. Related Project(s) P174049-South Sudan Provision of Essential Health Services Project Additional Financing 11/19/2020 Page 9 of 9