The World Bank Report No: ISR10737 Implementation Status & Results Nigeria Nigeria States Health Investment Project (P120798) Public Disclosure Copy Operation Name: Nigeria States Health Investment Project (P120798) Project Stage: Implementation Seq.No: 3 Status: ARCHIVED Archive Date: 18-Jun-2013 Country: Nigeria Approval FY: 2012 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 12-Apr-2012 Original Closing Date 30-Jun-2018 Planned Mid Term Review Date Last Archived ISR Date 25-Dec-2012 Effectiveness Date Revised Closing Date 30-Jun-2018 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase the delivery and use of high impact maternal and child health interventions and improve quality of care at selected health facilities in the participating states. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Results Based Financing using (i) PBF for outputs at health facilities and LGA PHC Departments (ii) 122.20 DLI at State and LGA levels (iii ) DFF at the health facility level to compare with PBF. Component 2: Technical Support that will support reforms; institutional strengthening; implementation 34.00 of PBF and DLI at the state, L GA and facility levels; and monitoring and evaluation. Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating High High Implementation Status Overview The Nigeria State Health Investment Project (NSHIP) was approved by the Board in April 12, 2012 and the project is now waiting effectiveness. Legislative approval of the borrowing plan by the National Assembly of the country was received in December 2012 and the harmonized document was subsequently endorsed by both houses. The Government of Nigeria (GoN) and the World Bank signed the Financing Agreements for the project and the HRITF grant on April 16, 2013. This will be followed up by the signing of the subsidiary financing agreements (SFA) between the GoN and the three states (Adamawa, Nasarawa and Ondo) for the roll-out of the project activities. With the ratification of the Project Implementation Manual the other significant effectiveness condition has been met and the project will become effective once one of the states signs the SFA. Page 1 of 5 The World Bank Report No: ISR10737 The implementation of the performance based financing (PBF) pre-pilot continued into the second quarter of 2013. The overall progress has been encouraging though the health facilities in Nasarawa and Adamawa are experiencing slight reductions of the quantity of key services delivered in the quarter beginning October 2012 due to delayed performance payments. For example, overall, outpatient visits per capita per year increased from 0.1 to 0.44 in Adamawa and 0.11 to 0.26 in Nasarawa from December 2011 to March 2013. In Public Disclosure Copy addition, the coverage of institutional delivery increased from 12% to 28% (assuming 7.2 fertility rate) in Adamawa and 11% to 34% (assuming 5.4 fertility rate,) in Nasarawa. Notably Ondo that used was lagging has been improving performance consistently since the 4th quarter of 2012. For example, outpatient visits per capita per year in Ondo increased from 0.09 in October 2012 to 0.17 in March 2013, and the institutional delivery increased from 17% to 33% during the same period (assuming 4.5 fertility rate). The states continue to learn from implementation and the last mission to the states offered opportunity for capacity building. Performance payments have become more regular since January 2014; the procurement process for the RBF Technical Assistance is almost completed ; The Baseline Household and Health facility Survey activities are ongoing and data collection for the household survey is expected to begin by July, 2014. In addition all project states have reported on their achievements on the Disbursement Linked Indicators for 2011-2012. Next critical actions include: (i) signing of the SFA by at least one state to trigger project effectiveness; (ii) retroactive payment for achievement of the DLIs by the states; and (iii) roll out of performance based financing and Decentralized facility financing in selected health facilities in all the LGAs in the states - 50% PBF and 50% DFF. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of 12-23 month old children fully Number Value 270644.00 378900.00 immunized Date 31-Dec-2008 31-Dec-2017 Comments This is the addition of the No new figure as project number of immunized children implementation has not for the 3 states for 2008 commenced (Adamawa: 78,280; Nasarawa: 86,237; Ondo: 106,227) Proportion of 12-23 month old children fully Percentage Value 19.10 21.00 49.00 immunized (Adamawa) Sub Type Public Disclosure Copy Supplemental Proportion of 12-23 month old children fully Percentage Value 16.10 39.00 45.00 immunized (Nasarawa) Sub Type Supplemental Proportion of 12-23 month old children fully Percentage Value 22.60 40.00 53.00 immunized (Ondo) Sub Type Supplemental Page 2 of 5 The World Bank Report No: ISR10737 Births (deliveries) attended by skilled health Number Value 76960.00 88503.00 personnel (number) Date 31-Dec-2010 05-Jun-2013 31-Dec-2017 Comments This is the addition of the No new figure as project Public Disclosure Copy number of births for the 3 implementation has not states for 2010 (Adamawa: commenced 24,520; Nasarawa: 23,193; Ondo: 29,247). Proportion of births attended by skilled health Percentage Value 14.60 46.00 25.00 personnel (Adamawa) Sub Type Supplemental Proportion of births attended by skilled health Percentage Value 33.80 43.00 45.00 personnel (Nasarawa) Sub Type Supplemental Proportion of births attended by skilled health Percentage Value 50.50 35.00 60.00 personnel (Ondo) Sub Type Supplemental Average Health Facility Quality of Care Score Percentage Value 0.00 68.47 Date 31-Mar-2013 Comments The value will be obtained Data for pre pilot LGAs Baseline plus 20 percentage from the baseline health points facility survey Number of outpatient visits by children under Number Value 346990.00 388598.00 five Date 31-Dec-2010 31-Dec-2017 Comments This represents addition of This represents addition of values for two states - values for two states - Nasarawa (36,591) and Ondo Nasarawa (40,982) and Ondo (301,372). Data for Nasarawa (347,616) not yet available. Direct project beneficiaries Number Value 0.00 Public Disclosure Copy Date 31-Dec-2017 Comments Female beneficiaries target: Baseline plus 10 percentage points Female beneficiaries Percentage Value 0.00 Sub Type Supplemental Intermediate Results Indicators Page 3 of 5 The World Bank Report No: ISR10737 Indicator Name Core Unit of Measure Baseline Current End Target TB Case Detection Rate Percentage Value 30.50 43.00 Date 31-Dec-2008 31-Dec-2017 Public Disclosure Copy Comments National TB & Leprosy No new figure as project Control Program Annual implementation has not Report commenced Proportion of on-duty technical staff present at Percentage Value 0.00 health facility on the day of the survey. Date 31-Dec-2016 Comments Project implementation has No new figure as project Baseline plus 25 percentage not commenced implementation has not points commenced Proportion of primary health facilities having Percentage Value 0.00 essential medicines and commodities in stock Date 31-Dec-2017 Comments Project implementation has No new figure as project Baseline plus 15 percentage not commenced implementation has not points commenced Number of LGA with ongoing PBF pilot Number Value 3.00 3.00 27.00 Date 31-Dec-2011 31-Mar-2013 30-Jun-2015 Comments 1 LGA under pre pilot in each of the 3 states Number of LGAs receiving grants linked to Number Value 0.00 30.00 performance Date 31-Dec-2017 Comments Project implementation has No new figure as project not commenced implementation has not commenced Number of states disclosing report cards Number Value 0.00 3.00 detailing LGA level performance made Date 30-Jun-2015 available in public domain Comments Project implementation has No new figure as project not commenced implementation has not Public Disclosure Copy commenced Data on Financial Performance (as of 25-Apr-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P120798 IDA-50940 Not Effective 12-Apr-2012 16-Apr-2013 30-Jun-2018 30-Jun-2018 P120798 IDA-Q8080 Effective 08-Mar-2012 14-Mar-2012 14-Mar-2012 15-Oct-2012 30-Jun-2013 P120798 TF-98512 Effective 11-Oct-2011 22-Dec-2011 22-Dec-2011 12-Dec-2012 30-Jun-2013 Page 4 of 5 The World Bank Report No: ISR10737 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P120798 IDA-50940 Not Effective XDR 96.40 96.40 0.00 0.00 96.40 0.00 P120798 IDA-Q8080 Effective USD 3.00 3.00 0.00 0.00 3.00 0.00 Public Disclosure Copy P120798 TF-98512 Effective USD 0.40 0.40 0.00 0.10 0.30 25.00 Disbursement Graph Key Decisions Regarding Implementation None Restructuring History Public Disclosure Copy There has been no restructuring to date. Related Projects There are no related projects. Page 5 of 5