Public Disclosure Copy The World Bank Implementation Status & Results Report Expanding Access to Reduce Health Inequities Project (APL III)--Former Health Sector Reform - Third Phase (APL III) (P10 Expanding Access to Reduce Health Inequities Project (APL III)--Former Health Sector Reform - Third Phase (APL III) (P10 LATIN AMERICA AND CARIBBEAN | Bolivia | Health, Nutrition and Population Global Practice | IBRD/IDA | Adaptable Program Loan | FY 2008 | Seq No: 16 | ARCHIVED on 09-Jun-2015 | ISR19321 | Implementing Agencies: Ministry of Health, Social Investment and Productive Fund (SPF) Key Dates Key Project Dates Board Approval date:24-Jan-2008 Effectiveness Date:19-Jun-2009 Planned Mid Term Review Date:30-Nov-2011 Actual Mid-Term Review Date:19-Aug-2013 Original Closing Date:31-Jan-2014 Revised Closing Date:31-Oct-2015 Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objectives for APL III are the same as those of the previous two phases: increasing access to good quality and culturally appropriate health services to improve the health of the population in general and to mothers and children in particular. As a medium-term objective, the APL series pursues reducing the infant and maternal mortality rates by one-third, as per the proposed indicators for the Program. Under APLs I and II an important set of policies and interventions were developed to strengthen the performance of the public health services. These policies and interventions aimed to improve child and maternal health status, including expansion of the insurance system (the Universal maternal and child insurance, SUMI, at present), the investments in primary health care, and the strengthening of cost-effective health interventions (PAI, IMCI). APL I introduced a basic health insurance (the Seguro B?sico de Salud, today SUMI) to reinforce provisions to mothers and children, and a new vaccination system and set of new management tools. APL II is implementing an expanded version of maternal and child insurance, by supporting the deployment of mobile health brigades (EXTENSA) as a way of expanding service delivery to underserved areas, and new management tools (performance agreements, and demand-driven investment policy) are being used. The Government has provided sustainability to health insurance as well as to the EXTENSA program that is now being absorbed by the regional and/or municipal budgets. The EXTENSA Unit in the MOH that was part of the APL II PIU is being incorporated in the structure of the MOH. All regions benefited with support from investments, mainly in primary care. The proposed APL III aims to sustain the trend in improving the IMR and accelerate the reduction of the MMR, which a recent modeling exercise shows to be a challenge. APL III would consolidate the strategies implemented under APLs I and II by: i) strengthening the regulatory capacity of national, regional and local levels to perform critical EFPH; ii) promoting the demand of maternal and infant health services through developing and enhancing the culturally appropriate maternal and infant health referral network; and iii) supporting implementation of the new expansion of the insurance system (Universal Health Insurance - SUSALUD. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Stewardship Role of Health Authorities - Essential Functions in Public Health:(Cost $1.84 M) 6/9/2015 Page 1 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Expanding Access to Reduce Health Inequities Project (APL III)--Former Health Sector Reform - Third Phase (APL III) (P10 Family, Community and Intercultural Health:(Cost $10.39 M) Health Insurance Program:(Cost $0.70 M) Project Administration:(Cost $0.80 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Satisfactory  Moderately Satisfactory Overall Risk Rating  Moderate  Moderate Implementation Status and Key Decisions 1. Results The Project is progressing well and its Project Development Objectives are likely to be achieved by Project closing in October 2015. 2. Disbursements: As of May 30, 2015, the project has disbursed 92% of the loan proceeds. It has completed important investments in civil works and equipment purchase for primary care health units in the prioritized municipalities, and substantial investments in the construction of the Onco-Hematologic Block of the Children Hospital of La Paz. 6/9/2015 Page 2 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Expanding Access to Reduce Health Inequities Project (APL III)--Former Health Sector Reform - Third Phase (APL III) (P10 Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  Moderate  Moderate Macroeconomic  --  Moderate  Moderate Sector Strategies and Policies  --  Moderate  Moderate Technical Design of Project or Program  --  Moderate  Moderate Institutional Capacity for Implementation and Sustainability  --  Moderate  Moderate Fiduciary  --  Moderate  Moderate Environment and Social  --  Low  Low Stakeholders  --  Moderate  Moderate Other  --  --  -- Overall  --  Moderate  Moderate Results 6/9/2015 Page 3 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Expanding Access to Reduce Health Inequities Project (APL III)--Former Health Sector Reform - Third Phase (APL III) (P10 Project Development Objective Indicators PHINDPDOTBL  Ratio between the percentage of pregnant women accessing four prenatal care visits in the areas of project intervention and the rest of the country. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.53 0.00 0.73 0.80 Date 31-Dec-2009 01-Nov-2013 31-Dec-2014 31-Oct-2015 PHINDPDOTBL  Ratio between the percentage of institutional deliveries in the areas of project intervention and the rest of the country. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.52 0.00 0.73 0.75 Date 31-Dec-2009 01-Nov-2013 31-Dec-2014 31-Oct-2015 PHINDPDOTBL  Porcentage of Target Population Enrolled in the Family Register Forms (Carpeta Familiar) in the Project Target Areas. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 40.00 63.00 60.00 Date 31-Dec-2009 31-Dec-2013 31-Dec-2014 31-Oct-2015 PHINDPDOTBL  Porcentage of 2 year old children covered with height growth control (CRED) in the intervention areas of the project. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 18.00 39.00 86.00 40.00 Date 31-Dec-2009 31-Dec-2013 31-Dec-2014 31-Oct-2015 PHINDPDOTBL  The modules included in the SNIS are fully implemented in the SEDES, and all the heads of the referral networks in the intervention areas. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/9/2015 Page 4 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Expanding Access to Reduce Health Inequities Project (APL III)--Former Health Sector Reform - Third Phase (APL III) (P10 Value 0.00 40.00 100.00 60.00 Date 31-Dec-2009 31-Dec-2013 31-Dec-2014 31-Oct-2015 Overall Comments The next ISR will present an update of the indicators progress as of September 2015. Intermediate Results Indicators PHINDIRITBL  Percentage of the health units applying the sector regulations norms and the PRONACS norms. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 20.00 45.60 40.00 Date 31-Dec-2008 31-Mar-2014 31-Dec-2014 31-Oct-2015 PHINDIRITBL  Percentage of health units in the target areas following approved normative to characterize health units at first and second level. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 78.00 20.00 Date 31-Dec-2009 -- 31-Dec-2014 31-Oct-2015 PHINDIRITBL  Percentage of civil works concluded in the health facilities in the areas of intervention (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 95.60 100.00 Date 31-Dec-2009 -- 31-Dec-2014 31-Oct-2015 Comments This indicator does not include the civil works related to build the Onco-Hematologic Block of the Children Hospital of La Paz. Only civil works previously defined before the project restructuring (most on primary care units) are counted in this indicator. 6/9/2015 Page 5 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Expanding Access to Reduce Health Inequities Project (APL III)--Former Health Sector Reform - Third Phase (APL III) (P10 PHINDIRITBL  Percentage of equipment installed in health facilities in the areas of intervention. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 100.00 100.00 Date 31-Dec-2009 -- 31-Dec-2014 31-Oct-2015 Comments This indicator corresponds to the equipment that was purchased and distributed to the health units before the last project restructuring. It does not include the equipment related to the Onco-Hematologic Block of the Children Hospital in La Paz. PHINDIRITBL  Percentage of user's population receiving services satisfied with the quality of the services received in the project areas. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 30.00 Date 31-Dec-2009 31-Mar-2014 31-Mar-2014 31-Oct-2015 Comments The Project Team received the first draft report of the satisfaction survey applied in the Second Semester of 2014 for patients of a sample of 58 health units in the project prioritized areas. The survey interviewed patients and families after receiving health services. The preliminary results of the satisfaction survey by Department are as follows: (a) Cochabamba (7 Municipalities) – 69% satisfied; (b) La Paz (9 Municipalities) – 78% satisfied; (c) Tarija (17 municipalities), 81% satisfied; (d) Oruro (25 municipalities), 78% satisfied. All results are above the expected average of 30% of patients satisfaction. We are expecting the final report to include the results in the next ISR. Overall Comments Data on Financial Performance Disbursements (by loan) 6/9/2015 Page 6 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Expanding Access to Reduce Health Inequities Project (APL III)--Former Health Sector Reform - Third Phase (APL III) (P10 Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P101206 IDA-43820 Effective XDR 11.70 6.85 4.85 6.30 0.55 92% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P101206 IDA-43820 Effective 24-Jan-2008 19-Sep-2008 19-Jun-2009 31-Jan-2014 31-Oct-2015 Cumulative Disbursements Restructuring History Level Approved on 12-Dec-2012 ,Level 2 Approved on 10-Jan-2014 ,Level 2 Approved on 14-Jul-2014 Related Project(s) There are no related projects. 6/9/2015 Page 7 of 7 Public Disclosure Copy