The World Bank Report No: ISR3474 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: 16 Status: ARCHIVED Last Modified Date: 16-Jun-2011 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 28-Dec-2010 Effectiveness Date 18-Mar-2004 Revised Closing Date 30-Jun-2011 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. Page 1 of 10 The World Bank Report No: ISR3474 An external review of the Sector Wide Approach (SWAp) process in Tanzania concluded that the SWAp has contributed to improvements in health outcomes and to improvements in Public Disclosure Copy 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. In terms of relevance, the external review came to the following conclusion: "Assessed in total, health sector strategies, priorities, plans, budgets and programs have been relevant to achieving the MDGs and health sector goals and targets throughout the evaluation period ... The organization of much of the external support to the sector under a SWAP agreement has helped to ensure that most remains relevant to the needs of the health sector and the national priorities expressed in MKUKUTA and the MDGs. Contributions to the Health Basket Fund have played a particularly important role in enabling one of the central strategies of health sector reform: strengthening council health services." HSDP II has been an integral part of this external support. The use of the health basket fund approach has proved to be an efficient mechanism for providing the Bank#s assistance to the health sector. The Health Basket Fund (HBF) is now around $90 million per year (increasing to $112 million in FY12), and represents about 15% of the total health sector budget. It is one of the few sources of discretionary expenditure for the sector. 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. The final 2010 DHS report has been released on May 26, 2011, and the indicators have been updated with this most recent data. They show generally positive trends across a number of indicators, including the ratio of the infant mortality rate between the richest and poorest income quintiles, which declined from 1.22 to 1.03, indicating that health services and positive health outcomes are becoming more available for the poor. The positive results across a number of indicators suggest that the project was successful in meeting its development objectives. 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 live births 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 Source: DHS 2010. Revised Changed from 85/1,000 in the first target exceeded additional financing Public Disclosure Copy 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) 1.03 (63:61) 1.08 quintile Date Date Date 01-Jan-1999 26-May-2011 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Source: DHS 2010. Target exceeded. Page 2 of 10 The World Bank Report No: ISR3474 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Under-five mortality rate 146.5/1000 live births 81/1000 live births 86/1000 live births Date Date Date 01-Jan-2003 04-Oct-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Source: DHS 2010. Revised HSSP III target is 79/1,000 live target exceeded births Indicator Baseline Current End Target Indicator Name Value Value Value Total fertility rate 15-49 5.6 births per woman of child 5.4 births per woman of child 5.4 births per woman of child bearing age bearing age bearing age Date Date Date Type Unit of Measure 01-Jan-1999 04-Oct-2010 31-Dec-2010 Custom Indicator Text Comment Comment Comment Source: DHS 2010. Revised Previous target of 4.5 is not Target achieved. 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 Target exceeded. Latest available Target in the PAD was 50 (an Public Disclosure Copy figure has since been updated. data from WDI increase of 1 year). This same increase has been applied to the revised baseline. Page 3 of 10 The World Bank Report No: ISR3474 Indicator Baseline Current End Target Public Disclosure Copy 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 Type Unit of Measure Comment Comment Comment Custom Indicator Number Figure in the PAD was 370 which Source: DHS 2010. This Target in PAD was 250, was based on surveillance data, represents a 21% reduction. representing a 32% reduction from not DHS Target partially achieved. the baseline. This target reflects a similar reduction over the 2004 baseline. Intermediate Results Indicators Indicator Baseline Current End Target Indicator Name Value Value Value The government's health budget per capita US$6.6 $16.09 (2009/10 actual) US$14 Date $18.57 (2010/11 estimate) Date 01-Jul-2003 Date 31-Dec-2010 Type Unit of Measure Comment 30-Jun-2011 Comment Custom Indicator Text Comment Increased from $11 as target from Source: PER 2010. Revised first additional financing target exceeded (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 Public Disclosure Copy 01-Jan-1999 01-Oct-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Source: DHS 2010. Target Not Previous target of 75% considered met due to ongoing staff shortages not achievable. Page 4 of 10 The World Bank Report No: ISR3474 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Percentage of clients seeking care at a health facility report to be UNK 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 Household Budget Survey 12/31/2009 likely to be exceeded. Indicator Baseline Current End Target Indicator Name Value Value Value The TB treatment completion rate ( cure rate ) 80% 88% 90% Date Date Date 01-Jan-2003 31-Dec-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Source: HMIS. Original target First AF target of 85% already exceeded. Revised target exceeded. substantially achieved. Indicator Baseline Current End Target Indicator Name Value Value Value Malnutrition (weight for age ) among children under five (%) 29 16 18 Date Date Date 01-Jul-2003 26-May-2011 31-Dec-2009 Type Unit of Measure Comment Comment Comment Custom Indicator Text Source: DHS 2010 (using DHS Original PAD target was 25, first 2004/05 methodology). Target AF target was 20. achieved. Public Disclosure Copy Indicator Baseline Current End Target Indicator Name Value Value Value Health workers trained pre-service to minimum qualifications and 899 6713 8599 certification requirements (total number of students enrolled) Date Date Date 01-Sep-2004 31-Dec-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Source: MOHSW HR data. From HSSP III Substantial progress made on target (76%). Page 5 of 10 The World Bank Report No: ISR3474 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Immunization DPT3/Penta under 1 (%) -- target is 2015 MDG 81 90.9 90 Date Date Date 31-Dec-1999 31-Dec-2010 31-Dec-2015 Type Unit of Measure Comment Comment Comment Custom Indicator Text Source: EPI 2010 Report. Target achieved Indicator Baseline Current End Target Indicator Name Value Value Value Patients treated for TB (number of cases for fiscal year ending date 64,298 63,364 66,000 shown) Date Date Date 30-Jun-2004 31-Dec-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Source: Global TB surveillance report. Target not achieved Indicator Baseline Current End Target Indicator Name Value Value Value Vitamin A supplementation for children 6-59 months (%) -- DHS data 12.5 60.8 50 Date Date Date 31-Dec-1999 01-Oct-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Source: DHS 2010. Target HSSP III target for 2015 is 80% exceeded. Indicator Baseline Current End Target Public Disclosure Copy 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 Source: DHS 2010. Target HSSP III target for 2015 is 30 exceeded. Page 6 of 10 The World Bank Report No: ISR3474 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Use of Insecticide Treated Nets by Vulnerable Groups 25% (under 5), 26% (pregnant) 72.6% (under 5), 67.6% (pregnant) 40% Date Date Date 01-Feb-2008 01-Oct-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Text Source: DHS 2010. Target substantially exceeded. Indicator Baseline Current End Target Indicator Name Value Value Value Availability of Emergency Obstetrical Care 5.00 20.00 Date Date Date 30-Dec-2005 31-Dec-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage DHS 2004/05 Awaiting survey results Indicator Baseline Current End Target 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 Source: National Malaria Control financing which supported this Program. Target met. Distribution activity. is completed. Indicator Baseline Current End Target Public Disclosure Copy 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 Source: HMIS. Target Achieved Basket funding reaches all Tanzanians, IDA represents 19% of total basket funds. Page 7 of 10 The World Bank Report No: ISR3474 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Female beneficiaries 50.80 Type Unit of Measure Sub-Type 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 Source: MOHSW HR System. Target exceeded. Total number, proportion attributable to IDA funds not available. Indicator Baseline Current End Target Indicator Name Value Value Value Children immunized 1545536.00 1350000.00 Date Date Date 31-Dec-2010 31-Dec-2010 Type Unit of Measure Comment Comment Comment Core Indicator Number Source: HMIS. Target Achieved Total number, proportion Public Disclosure Copy attributable to IDA funds not available. Page 8 of 10 The World Bank Report No: ISR3474 Indicator Baseline Current End Target Public Disclosure Copy 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 Source: HMIS. Target Exceeded. Total number, proportion attributable to IDA funds not available. Data on Financial Performance (as of 27-May-2011) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P082335 IDA-38410 Closed 16-Dec-2003 13-Jan-2004 18-Mar-2004 31-Dec-2010 P082335 IDA-38411 Closed 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 30-Jun-2011 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 Closed XDR 27.90 27.90 0.00 27.90 0.00 100.00 P082335 IDA-38411 Closed XDR 40.00 39.97 0.03 39.97 0.00 100.00 P082335 IDA-46770 Effective XDR 25.20 25.20 0.00 21.23 3.97 84.00 P082335 IDA-H0710 Closed XDR 17.40 17.40 0.00 17.40 0.00 100.00 Public Disclosure Copy Disbursement Graph Page 9 of 10 The World Bank Report No: ISR3474 Public Disclosure Copy Key Decisions Regarding Implementation The project will close, as planned, on June 30, 2011. 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 10 of 10