The World Bank Report No: ISR1923 Implementation Status & Results Tanzania Public Disclosure Copy Second Health Sector Development Project (P082335) Operation Name: Second Health Sector Development Project (P082335) Project Stage: Implementation Seq.No: 15 Status: ARCHIVED Last Modified Date: 16-Dec-2010 Country: Tanzania Approval FY: 2004 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Adaptable Program Loan Implementing Agency(ies): Ministry of Health and Social Welfare, Ministry of Regional Administration and Local Government Key Dates Board Approval Date 16-Dec-2003 Original Closing Date 31-Dec-2007 Planned Mid Term Review Date 13-Mar-2006 Last Archived ISR Date 14-Jun-2010 Effectiveness Date 18-Mar-2004 Revised Closing Date 31-Dec-2010 Actual Mid Term Review Date 21-Mar-2006 Project Development Objectives Project Development Objective (from Project Appraisal Document) The objective of the phase II project is to achieve improvements in the provision of quality health services through continuing to support the reforms, capacity development and improved management of resources, while placing a greater emphasis on quality. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost IMPROVING DISTRICT LEVEL HEALTH SERVICES 0.00 STRENGTHENING THE MANAGEMENT OF HOSPITAL CARE & CENTRAL SUPPORT TO 0.00 QUALITY, FINANCING & HUMAN RESOURCES Overall Ratings Public Disclosure Copy Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Implementation Status Overview In Tanzania, this project, and the Health Basket Fund generally, have contributed to a reduction in the infant mortality rate by almost half, from 99 deaths per 1,000 live births in 1999 to 51 in 2010. This brings Tanzania within reach of the child mortality Millennium Development Goal. There was also a 44% reduction in under-five mortality rate from 144 deaths per 1,000 live births in 1999 to 81 in 2010 due to an increased proportion of children under five sleeping under bed nets (from 36.3% in 2007/8 to 72.6% in 2009/10), increased vaccination coverage, and improved functioning Integrated Management of Childhood Illness (IMCI) at the facility and community levels. The Maternal Mortality Ratio also decreased over 20% from 578 per 100,000 live births in 2004 to 454 in 2010, resulting in almost 2,000 fewer maternal deaths per year. An external review of the SWAp process in Tanzania Page 1 of 9 The World Bank Report No: ISR1923 concluded that the "SWAp has contributed to improvements in health outcomes and to improvements in the quality of health services at community level. These improvements can, in turn, be plausibly linked to progress toward MDG and PRSP/MKUKUTA goals, especially relating to infant and child mortality". Public Disclosure Copy The Health Basket Fund (HBF) is now approaching $90 million per year, which represents about 15% of the total health sector budget, and one of the few sources of discretionary expenditure. The IDA funding represents about 17% of the total, making the Bank the second largest financier of the Basket. The Bank has played a key role in institutionalizing the HBF approach, and basket funds have been used extensively to finance medical supplies and drugs, as well as to get funds to the front line for direct service delivery. Results Project Development Objective Indicators Indicator Baseline Current End Target Indicator Name Value Value Value Infant Mortality Rate (IMR) 99/1000 live births 51/1000 (2009/10 DHS) 54/1000 live births Date Date Date 01-Jan-1999 04-Oct-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Revised target exceeded Changed from 85/1,000 in the first additional financing Indicator Baseline Current End Target Indicator Name Value Value Value Ratio of the IMR of the poorest quintile to the IMR of the least poor 1.29 (113:88) 82:73 (1.12) 1.08 quintile Date Date Date 01-Jan-1999 30-Oct-2009 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text On track. Update not yet available, but will be in DHS Final Report, expected December, 2010. Public Disclosure Copy Indicator Baseline Current End Target Indicator Name Value Value Value Under-five mortality rate 146.5/1000 live births 81/1000 live births (per 2007/8 86/1000 live births Date THMIS) Date 01-Jan-2003 Date 31-Dec-2010 Type Unit of Measure Comment 04-Oct-2010 Comment Custom Indicator Text Comment HSSP III target is 79/1,000 live Revised target exceeded births Page 2 of 9 The World Bank Report No: ISR1923 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Total fertility rate 15-49 5.6 births per woman of child 5.4 per 2009/10 DHS 5.4 births per woman of child bearing age Date bearing age Date 04-Oct-2010 Date Type Unit of Measure 01-Jan-1999 Comment 31-Dec-2010 Custom Indicator Text Comment Revised Target achieved. Comment Previous target of 4.5 is not considered achievable due to lack of government attention to this issue. Indicator Baseline Current End Target Indicator Name Value Value Value Life Expectancy at Birth 51.70 55.70 52.70 Date Date Date 31-Dec-2002 31-Dec-2008 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number Value in the PAD was 49. This Latest available data from WDI Target in the PAD was 50 (an figure has since been updated. increase of 1 year). This same increase has been applied to the revised baseline. Indicator Baseline Current End Target Indicator Name Value Value Value Maternal Mortality Ratio 578.00 454.00 391.00 Date Date Date 31-Dec-2004 30-Sep-2010 31-Dec-2010 Public Disclosure Copy Type Unit of Measure Comment Comment Comment Custom Indicator Number Figure in the PAD was 370 which DHS 2009/10. This represents a Target in PAD was 250, was based on surveillance data, 21% reduction. Target partially representing a 32% reduction from not DHS achieved. the baseline. This target reflects a similar reduction over the 2004 baseline. Intermediate Results Indicators Page 3 of 9 The World Bank Report No: ISR1923 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value The government's health budget per capita US$6.6 US$13.98 in FY08/09 (actual) US$14 Date Date Date 01-Jul-2003 01-Oct-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Achieved Increased from $11 as target from first additional financing (12/31/2009) Indicator Baseline Current End Target Indicator Name Value Value Value The proportion of births attended by a skilled health worker 47% 51% 57% Date Date Date 01-Jan-1999 01-Oct-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Target Not met due to ongoing Previous target of 75% considered staff shortages not achievable. Indicator Baseline Current End Target Indicator Name Value Value Value Percentage of clients seeking care at a health facility report to be UNK 62% 68% satisfied Date Date Date 01-Jul-2003 30-Oct-2009 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Indicator will not be updated until Previous target of 65% for 2012 Housefhold Budget Survey 12/31/2009 likely to be exceeded. Public Disclosure Copy Indicator Baseline Current End Target Indicator Name Value Value Value The TB treatment completion rate ( cure rate ) 80% 87.8% 90% Date Date Date 01-Jan-2003 31-Dec-2009 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Original target exceeded. Revised First AF target of 85% already target substantially achieved. exceeded. Page 4 of 9 The World Bank Report No: ISR1923 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Malnutrition (weight for age ) among children under five (%) 29 20.7 18 Date Date Date 01-Jul-2003 01-Oct-2010 31-Dec-2009 Type Unit of Measure Comment Comment Comment Custom Indicator Text Target substantially achieved. Original PAD target was 25, first DHS 2009/10 (using DHS 2004/05 AF target was 20. methodology). Target Substantially Achieved Indicator Baseline Current End Target Indicator Name Value Value Value Health workers trained pre-service to minimum qualifications and 899 6450 8599 certification requirements (total number of students enrolled) Date Date Date 01-Sep-2004 31-Dec-2009 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text No change over 2008 enrollment. From HSSP III Target partially achieved (75%). Indicator Baseline Current End Target Indicator Name Value Value Value Immunization DPT3/Penta under 1 (%) -- target is 2015 MDG 81 85.7% 90 Date Date Date 31-Dec-1999 31-Dec-2009 31-Dec-2015 Type Unit of Measure Comment Comment Comment Custom Indicator Text Partially achieved Public Disclosure Copy Indicator Baseline Current End Target Indicator Name Value Value Value Patients treated for TB (number of cases for fiscal year ending date 64,298 64,267 66,000 shown) Date Date Date 30-Jun-2004 31-Dec-2009 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Target not achieved. Page 5 of 9 The World Bank Report No: ISR1923 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Vitamin A supplementation for children 6-59 months (%) -- DHS data 12.5 60.3 50 Date Date Date 31-Dec-1999 01-Oct-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text DHS 2009/10. Target exceeded. HSSP III target for 2015 is 80% Indicator Baseline Current End Target Indicator Name Value Value Value Modern contraceptive prevalence women age 15-49 (% - married 16.9 27 25 women only, from DHS) Date Date Date 31-Dec-1999 01-Oct-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text DHS 2009/10, Target achieved. HSSP III target for 2015 is 30 Indicator Baseline Current End Target Indicator Name Value Value Value Use of Insecticide Treated Nets by Vulnerable Groups 25% (under 5), 26% (pregnant) 64.1% (under 5), 57.1% (pregnant) 40% Date Date Date 01-Feb-2008 01-Oct-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Target substantially exceeded. Indicator Baseline Current End Target Indicator Name Value Value Value Availability of Emergency Obstetrical Care 5.00 5.00 20.00 Public Disclosure Copy Date Date Date 30-Dec-2005 30-Oct-2009 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage DHS 2004/05 Survey still be completed, expected January, 2011. Page 6 of 9 The World Bank Report No: ISR1923 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Long-lasting insecticide-treated malaria nets purchased and/or 0.00 2400000.00 2400000.00 distributed Date Date Date 02-Jul-2007 01-Dec-2009 31-Dec-2009 Type Unit of Measure Comment Comment Comment Core Indicator Number Beginning of first additional Distribution is completed. financing which supported this activity. Indicator Baseline Current End Target Indicator Name Value Value Value Direct project beneficiaries 7990000.00 7800000.00 Date Date Date 31-Dec-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Core Indicator Number Target Achieved Basket funding reaches all Tanzanians, IDA represents 19% of total basket funds. Indicator Baseline Current End Target Indicator Name Value Value Value Female beneficiaries 50.80 Type Unit of Measure Sub-Type Public Disclosure Copy Core Indicator Percentage Supplemental Indicator Baseline Current End Target Indicator Name Value Value Value Health personnel receiving training 13000.00 3600.00 Date Date Date 01-Sep-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Core Indicator Number Target exceeded. Total number, proportion attributable to IDA funds not available. Page 7 of 9 The World Bank Report No: ISR1923 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Children immunized 1408000.00 1350000.00 Date Date Date 31-Dec-2009 31-Dec-2010 Type Unit of Measure Comment Comment Comment Core Indicator Number Target Achieved Total number, proportion attributable to IDA funds not available. Indicator Baseline Current End Target Indicator Name Value Value Value Children receiving a dose of vitamin A 6626367.00 6500000.00 Date Date Date 31-Dec-2009 31-Dec-2010 Type Unit of Measure Comment Comment Comment Core Indicator Number Target Exceeded. Total number, proportion attributable to IDA funds not available. Data on Financial Performance (as of 14-Dec-2010) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P082335 IDA-38410 Effective 16-Dec-2003 13-Jan-2004 18-Mar-2004 31-Dec-2010 P082335 IDA-38411 Effective 05-Jul-2007 31-Jul-2007 28-Aug-2007 31-Dec-2010 P082335 IDA-46770 Effective 22-Dec-2009 29-Jan-2010 22-Feb-2010 31-Dec-2010 Public Disclosure Copy P082335 IDA-H0710 Closed 16-Dec-2003 13-Jan-2004 18-Mar-2004 31-Dec-2007 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P082335 IDA-38410 Effective XDR 27.90 27.90 0.00 27.90 0.00 100.00 P082335 IDA-38411 Effective XDR 40.00 40.00 0.00 39.36 0.64 98.00 P082335 IDA-46770 Effective XDR 25.20 25.20 0.00 20.69 4.51 82.00 P082335 IDA-H0710 Closed XDR 17.40 17.40 0.00 17.40 0.00 100.00 Disbursement Graph Page 8 of 9 The World Bank Report No: ISR1923 Public Disclosure Copy Key Decisions Regarding Implementation No decisions to be disclosed at this time Restructuring History There has been no restructuring to date. Related Projects P105093-TZ-Health Sector Development II Scale-Up, P119067-Tanzania Health Sector Development Project II - Additional Financing FY10 Public Disclosure Copy Page 9 of 9