The World Bank Report No: ISR6240 Implementation Status & Results Ghana Nutrition and Malaria Control for Child Survival (P105092) Public Disclosure Copy Operation Name: Nutrition and Malaria Control for Child Survival (P105092) Project Stage: Implementation Seq.No: 14 Status: ARCHIVED Archive Date: 12-Dec-2011 Country: Ghana Approval FY: 2008 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of Health; Ghana Health Services Key Dates Board Approval Date 03-Jul-2007 Original Closing Date 31-Mar-2012 Planned Mid Term Review Date Last Archived ISR Date 12-Dec-2011 Effectiveness Date 07-Sep-2007 Revised Closing Date 31-Mar-2013 Actual Mid Term Review Date 07-Dec-2009 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to improve utilization of selected community-based health and nutrition services for children under the age of two and pregnant women in the selected districts. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Institutional Strengthening for coordination, implementation and outcomes 2.22 Community-based Health and Nutrition Service delivery 12.98 Malaria Prevention 9.80 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Moderately Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview The likelihood of achieving project development objectives has improved and therefore the PDO rating has been upgraded to Satisfactory. The overall implementation is maintained at moderately satisfactory. The project performance has continued to improve since March, 2011 under the management of the Policy, Planning, Monitoring and Evaluation (PPME)/ Ghana Health Service (GHS) and the more active participation of the technical departments as well as regional and district health management teams in the delivery of community based health and nutrition services. Page 1 of 6 The World Bank Report No: ISR6240 Development of policies and strategies has progressed significantly since the last review meeting in September, 2011. Intensive consultations have been carried out with many stakeholders on these policies and strategies. While coordination has improved at all levels, the oversight committees at the lower levels such as the district advisory committees and the community implementation committees are not functioning as expected. Public Disclosure Copy Efforts to improve the monitoring and evaluation system are on track as piloting of the new system has been completed and plans are underway to roll it out into all the project target districts. The pilot was a proof of concept and a demonstration of how data collation and analysis can be improved for better results and timely reporting on the project. Scale-up of community-based health and nutrition services has progressed according to plan with activities initiated in 20 districts in the Central, Volta and Western regions. However the target agreed for the new districts that were beginning was not reached; accounting for the moderately satisfactory (MS) rating of implementation progress (IP). Once scale-up in all districts is completed the implementation progress will be upgraded to satisfactory. An institutional assessment of the nutrition area was carried out in 2011 and the report that was submitted to the government was discussed during the February 2012 mission and agreement was reached as to how carry forward the recommendations. Locations Country First Administrative Division Location Planned Actual Ghana Not Entered Wiawso Ghana Volta Region Volta Region Ghana Upper West Region Upper West Region Ghana Upper East Region Upper East Region Ghana Northern Region Northern Region Ghana Ashanti Region Kumasi Ghana Central Region Central Region Ghana Greater Accra Region Accra Results Public Disclosure Copy Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Proportion of children under two years of age Text Value 63% (DHS - national data) NR - 58.6% 87% with diarrhoea who receive oral re-hydration 21.9% (data from 19 districts UER - 83.7% therapy. beginning 4/14/08) UWR - 83.8% Date 03-Sep-2003 30-Sep-2011 31-Mar-2013 Comments Source: Routine project data shows project on course. Page 2 of 6 The World Bank Report No: ISR6240 Proportion of infants between 6-9 months of Text Value 58% (MICS - national data) NR - 92% 73% age who receive semi-solid/solid foods in 66% (data from 19 districts UER - 100% addition to breast milk in the past 24 hours. beginning 4/14/08) UWR - 95.9% Public Disclosure Copy Date 03-Sep-2006 30-Sep-2011 31-Mar-2013 Comments Source: Routine project data. Data from the three regions shows progress continues to be good. Proportion of pregnant women and children Text Value 46% (NMCP) and 22% (MICS 46% (NMCP) and 22% (MICS 60% and 40% respectively under five years of age who sleep under LLINs 2006 - national data) 2006 - national data the night preceding the survey reaches 60% respectively.. 41.0% (data and 40% respectively from 19 districts beginning 4/14/08) Date 03-Sep-2003 17-Feb-2012 31-Mar-2013 Comments Data will be available when the post hung up survey is completed by June 2012. Proportion of infants under six months of age Text Value 54% (MICS - national data) NR - 70.7% 69% who are exclusively breastfed in the past 24 55.7% (data from 19 districts UER - 81.7% hours. beginning (4/14/08) UWR - 83.4% Date 03-Sep-2006 30-Sep-2011 31-Mar-2013 Comments Source: Routine Monitoring. Data from the NR, UER and UWR indicates progress continues to be made. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Proportion of households having at least two Text Value 16.7% (data from 19 districts 16.7% (data from 19 districts 80% LLINs. beginning 4/14/08) beginning 4/14/08) Date 12-Feb-2007 30-Sep-2011 31-Mar-2012 Public Disclosure Copy Comments To be collected through post LLINs hang up survey to be completed by June 30, 2012. Proportion of children between 6 and 59 Text Value 78% (DHS 2003; Nat'l NR - 59.2% 80% months of age who have received at least one average) 81.0% (data from 19 UER - 62/2% vitamin A supplement in the last six months. districts beginning 4/14/08) UWR - 50.9% Date 03-Sep-2003 30-Sep-2011 31-Mar-2013 Comments While data from national campaigns where Vit A is Page 3 of 6 The World Bank Report No: ISR6240 given to e very child is not captured in the child health registers, this indicator is being tracked more seriously Public Disclosure Copy to improve performance and reporting. Proportion of caretakers of children under 2yrs Text Value 12.7% (data from 19 districts 12.7% (data from 19 districts 60% of age who were able to cite at least two beginning 4/14/08) beginning (4/14/08) danger signs in children needing professional Date 12-Feb-2007 30-Sep-2011 31-Mar-2013 medical attention. Comments On course to be collected by the end line survey December 2012 and January 2013. Proportion of new mothers who receive high- Text Value 43% (DHS - national data) NR - 76.5% 75% dosage vitamin A supplements within 8 weeks 29.1% (data from 19 districts UER - 72.2% of delivery. beginning 4/14/08) UWR - 56.7% Date 03-Sep-2003 30-Sep-2011 31-Mar-2012 Comments Source: Routine project data. No. of new mothers as denominator for calculating % not consistent. New registration for 0-2yrs used. Proportion of mothers of children under two Text Value 69% (DHS - national data) 69% (DHS - national data) 79% years of age who had at least 4 prenatal care 26.3% (data from 19 districts 26.3 (data from 19 districts) visits during their most recent pregnancy. beginning 4/14/08) Date 03-Sep-2003 30-Sep-2011 31-Mar-2012 Comments Report format reviewed. It was dropped from the reporting form during the last review. It is one of the indicators for which collection of data will be difficult as the next DHS will Public Disclosure Copy be carried out after project close. However MICs data will be available to throwlight on the indicator by Decemeber, 2012. difficult. Proportion of children under 2yrs of age being Text Value 48.3% (data from 19 districts NR - 88.8% 75% weighed regularly (2 times in 3 months). beginning 4/14/08) UER - 81.1% UWR - 93.6% Date 12-Feb-2007 30-Sep-2011 31-Mar-2013 Comments Target on track Page 4 of 6 The World Bank Report No: ISR6240 National nutrition policy developed. Text Value National nutrition policy is not Nutrition policy document Final Policy available available available. Date 12-Feb-2007 17-Feb-2012 31-Dec-2011 Public Disclosure Copy Comments Final report sent to Attorney General's Department for drafting of legal document. Proportion of planned supervision and support Text Value 0% NR - 32% 75% activities by districts in the intervention areas UER - 94% having been conducted. UWR - Date 12-Feb-2007 30-Sep-2011 31-Mar-2013 Comments Source: Routine project data. The project team is working with the regions that are lagging to improve their performance. Health personnel receiving training Number Value 0.00 2288.00 2400.00 Date 03-Jul-2007 30-Sep-2011 03-Mar-2013 Comments Source: Routine project data. Value: Data not available Increased from 1,350 to 2288 Comments: Targets to be between June and September estimated and agreed by Dec 2011 2011 Long-lasting insecticide-treated malaria nets Number Value 0.00 1100000.00 1550000.00 purchased and/or distributed Date 03-Jul-2007 30-Sep-2011 31-Mar-2013 Comments Restructuring Source: Project data. Project on course to meet target. Data on Financial Performance (as of 06-Jan-2012) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date Public Disclosure Copy P105092 IDA-43460 Effective 03-Jul-2007 08-Aug-2007 07-Sep-2007 31-Mar-2013 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P105092 IDA-43460 Effective XDR 16.40 16.40 0.00 8.23 8.17 50.00 Disbursement Graph Page 5 of 6 The World Bank Report No: ISR6240 Public Disclosure Copy Key Decisions Regarding Implementation (i) Project will scale-up to all districts and communities by June, 2012. (ii) In order to improve the functioning of the oversight committees at the district and community levels, the Regional Health and District Health Management Teams will carry out massive sensitization programs for the district chief executive officers and community leaders about the importance of the program and their participation in it. (iii) With support from the World Bank, the project implementation team will develop participatory mechanisms to strengthen collaboration among key actors at the district and community levels, and improve community participation in M&E processes. The participatory monitoring process will also aim to enhance accountability and responsibility of key players in the delivery of the project activities at the community level. (iv) The new monitoring and evaluation system will be rolled out to all project districts by June, 2012. Restructuring History Public Disclosure Copy Level two Approved on 11-Jul-2010 Related Projects There are no related projects. Page 6 of 6