The World Bank Report No: ISR9485 Implementation Status & Results Nepal Nepal: Second HNP and HIV/AIDS Project (P117417) Public Disclosure Copy Operation Name: Nepal: Second HNP and HIV/AIDS Project (P117417) Project Stage: Implementation Seq.No: 5 Status: ARCHIVED Archive Date: 07-Jun-2013 Country: Nepal Approval FY: 2010 Product Line: IBRD/IDA Region: SOUTH ASIA Lending Instrument: Sector Investment and Maintenance Loan Implementing Agency(ies): Key Dates Board Approval Date 20-Apr-2010 Original Closing Date 15-Jul-2015 Planned Mid Term Review Date 30-Jan-2013 Last Archived ISR Date 19-Nov-2012 Effectiveness Date 04-Oct-2010 Revised Closing Date 15-Jul-2015 Actual Mid Term Review Date 28-Jan-2013 Project Development Objectives Project Development Objective (from Project Appraisal Document) To enable the Government of Nepal to increase access to essential health care services and their utilization by the underserved andthe poor. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Health Service Delivery 114.42 Health Systems Strengthening 14.73 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Satisfactory Moderately Satisfactory Moderately Satisfactory Public Disclosure Copy Overall Implementation Progress (IP) Overall Risk Rating Substantial Implementation Status Overview The third Joint Annual Review (JAR) of the Nepal Health Sector Program II (NHSP II) took place from January 28-30, 2013. This coincided with, and served as, the mid-term review of the program. The JAR was organized by the Ministry of Health and Population (MoHP) with participation by various line agencies of the Government of Nepal (GoN), External Development Partners (EDPs), civil society organizations and others. MoHP prepared a number of reports as outlined in the Joint Financing Arrangement and these reports, along with the independently prepared Mid-Term Review Report, formed the basis for the discussions during the JAR. The reports are available on the MoHP's website. The JAR assessed the performance of NHSP II against its stated objectives as elaborated in the results framework. This assessment was based on data from the Nepal Demographic and Health Survey (NDHS 2011), the latest Household Survey (2012), the Service Tracking Survey (STS 2012), and the Health Management Information System Page 1 of 7 The World Bank Report No: ISR9485 (HMIS). Progress is visible in a number of areas especially in the PDO indicators where two out of three indicators have surpassed the end of project targets: Coverage of skilled birth attendance has increased to more than 46% surpassing the end of project target of 35%. Similarly, coverage of IFA has increased to 91%, against the end of project target of 87% and immunization coverage is maintained at 86% since the last reporting period. Progress has also been made on a broad range of indicators including exclusive breastfeeding, coverage of vitamin A supplementation for children under 5, etc. At the same time, there are areas where performance is lagging and require focused attention in the coming year (e. Public Disclosure Copy g. contraceptive prevalence rate, equity of access to quality services, vacant positions). Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Mothers taking IFA during last pregnancy Percentage Value 81.30 91.10 87.00 increased Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Comments 70.5% for the poorest income Source: 2012 Household 75% for the poorest income quintile Survey (HHS). 2012 data quintile reflects those who attended ANC. Poorest quintile 93.6% Fully immunized children increased Percentage Value 88.80 86.00 90.00 Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Comments 82.6% for poorest income Data source: HMIS 2012. 88% for poorest income quintile Data is % of one-year old quintile children immunized against measles. Skilled attendance at birth increased Percentage Value 28.80 46.30 35.00 Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Comments 8.5% for the poorest income Data source: 2012 HHS. 25% for the poorest income quintile NDHS data for last 5 years, quintile Public Disclosure Copy HHS data for last 1 year. Poorest quintile 43.7% Intermediate Results Indicators Page 2 of 7 The World Bank Report No: ISR9485 Indicator Name Core Unit of Measure Baseline Current End Target Pregnant women receiving antenatal care Number Value 2624101.00 3972430.00 2875850.00 during a visit to a health provider (number) Date 01-Jan-2010 30-Nov-2012 15-Jul-2015 Public Disclosure Copy Comments This figure is based on the For the year 2012, it is baseline coverage of 87%. 670,841. The figure is based Assuming pregnancy at 3% of on coverage of 84.8% the population and using CBS coverage as per NDHS 2011 population projection (medium and with a population of variant) for 2011 26,494,504 (final) as of census 2011 and assuming pregnancy at 3%. The 2012 HHS did not measure. Children immunized (number) Number Value 583819.00 569356.00 648476.00 Date 01-Jan-2010 30-Aug-2011 15-Jul-2015 Comments This figure is based on the The figure is based on baseline coverage of 88.8% coverage of 86.6%, the final and using DHS 2006 for the results of the NDHS survey. proportion of children 12-23 months; and CBS population Immunization coverage was projection (medium variant) not included in the 2012 HHS. for 2011 Health facilities constructed, renovated, and/or Number Value 0.00 527.00 equipped (number) Date 01-Jan-2010 30-Jan-2012 15-Jul-2015 Comments Data source: DUDBC. No target is set as this The figure shows all facilities indicators is not part of the under construction / results matrix for the project. renovation. Updated data not available from DUDBC at the time of this ISR. Public Disclosure Copy Health personnel receiving training (number) Number Value 0.00 610.00 550.00 Date 01-Jan-2010 16-Oct-2012 15-Jul-2015 Comments Source of data: IPR second A total of 5000 FCHVs trimester 2011/12. recruited, trained & deployed over the life of the project. Updated data not available at 5,000 is cumulative, 550 is the time of this ISR. the yearly target. Additional Female Community Health Number Value 0.00 3864.00 550.00 Volunteers deployed Date 31-Dec-2009 31-Dec-2012 15-Jul-2015 Page 3 of 7 The World Bank Report No: ISR9485 Comments Data source: HMIS. A total of 5000 FCHVs recruited, trained & deployed 217 additional for this over the life of the project. reporting period. 5,000 is cumulative, 550 is Public Disclosure Copy the yearly target. PHC centers providing Basic Emergency Percentage Value 23.00 39.00 70.00 Obstetric Services increased Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Comments Data source: Service Tracking Survey 2012. Survey indicator is "% of PHCCs providing BEONC signal functions 24/7" Health care finance strategy developed Yes/No Value No No Yes Date 31-Jan-2013 15-Jul-2015 Comments MoHP has decided to pilot health insurance in 5 districts (Banke, Kailali, Baglungm, Ilam, and Sarlahi). The Bank and other EDPs are providing support for the design of the pilot. Social audits implemented in health facilities Percentage Value 0.00 21.00 25.00 Date 15-Jul-2010 16-Oct-2012 15-Jul-2015 Comments Data source: Service Tracking Survey 2012. 21 percent of health facilities have undertaken social audits as per MOPH guidelines in the last FY Public Disclosure Copy Actions in GAAP implemented Percentage Value 60.00 70.00 90.00 Date 31-Dec-2009 30-Jan-2012 15-Jul-2015 Comments Data source: MOHP, PPICD. Additional SBAs deployed Number Value 0.00 1075.00 500.00 Date 30-Nov-2012 15-Jul-2015 Comments Source of data: NHTC/FHD. A total of 5000 (cumulative) additional SBAs recruited & 1,075 additional SBAs deployed over the life of the deployed over 2011's 2,562. project. Page 4 of 7 The World Bank Report No: ISR9485 PHC facilities with essential drug stock outs >1 Percentage Value 67.00 75.10 50.00 week decreased Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Comments Source: STS 2012. Public Disclosure Copy The STS tracks tracer drug stock outs (not all essential drugs) over time. Percent of MOHP budget allocated to EHCS Percentage Value 70.00 75.01 75.00 Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Comments Data source: AWPB Married women (15-49) with unmet need for Percentage Value 26.30 27.00 18.00 family planning reduced Date 31-Dec-2009 16-Oct-2012 15-Jul-2015 Comments Data source: Family Planning, Data source: NDHS 2011 Maternal, Newborn and Child 31.1% in lowest income Health quintile. Situation in Rural Nepal: A Mid-term Survey for NFHP 2012 HHS did not include II, March 2010 question on unmet need. HIV prevention services for IDUs increased Percentage Value 30.00 71.40 50.00 Date 31-Dec-2009 14-Jul-2011 15-Jul-2015 Comments Prevention services coverage Data source: 2011 IBBS. This Prevention services coverage for MSM and FSWs 31% and is not a nationally for MSM and FSWs 50% and 80% respectively representative survey as it at least 80% respectively covered only Kathmandu Valley and Pokhara. The final report for IBBS 2012 has not been produced yet. 2011 IBBS 60% for FSWs in Kathmandu Valley. 2011 IBBS survey did not include Public Disclosure Copy MSM. Vitamin A coverage maintained in children 6-59 Percentage Value 90.00 90.20 90.00 months Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Comments Data source: HHS 2012 91.5% for lowest quintile. Diarrheal cases among under 5 children with Percentage Value 7.00 21.90 40.00 zinc and ORS increased Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Page 5 of 7 The World Bank Report No: ISR9485 Comments The midterm 2009 NFHP Data source: HHS 2012. survey does not have an indicator for zinc and ORS 21.1% for the lowest quintile. combined so the baseline Public Disclosure Copy value is for the proportion of children <5yrs treated with zinc. Data source: Family Planning, Maternal, Newborn and Child Health Situation in Rural Nepal: A Mid-term Survey for NFHP II, March 2010 Pregnant women attending at least one ante- Percentage Value 87.00 84.80 92.00 natal consultation increased Date 31-Dec-2009 16-Oct-2012 15-Jul-2015 Comments Data source: final results of the NDHS survey, 2011. 2012 HHS only tracked % of pregnant women attending at least four ANC visits (48.1%). Exclusively breastfed children in first 6 months Percentage Value 53.00 68.70 60.00 increased Date 31-Dec-2007 30-Nov-2012 15-Jul-2015 Comments Data source: HHS 2012 Poorest quintile: 71.9% TB treatment success rate increased Percentage Value 85.00 90.00 89.00 Date 31-Dec-2009 31-Dec-2012 15-Jul-2015 Comments Source: HMIS 2012 Modern contraceptive use among women Percentage Value 45.10 43.10 55.00 increased Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Public Disclosure Copy Comments Family Planning, Maternal, Data source: HHS 2012 Newborn and Child Health (married women of Situation in Rural Nepal: reproductive age). A Mid-term Survey for NFHP II, March 2010 Lowest quintile: 47.6% (HHS 2012) Data on Financial Performance (as of 19-May-2013) Financial Agreement(s) Key Dates Page 6 of 7 The World Bank Report No: ISR9485 Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P117417 IDA-47070 Effective 20-Apr-2010 18-Aug-2010 04-Oct-2010 15-Jul-2015 15-Jul-2015 P117417 IDA-H5570 Effective 20-Apr-2010 18-Aug-2010 04-Oct-2010 15-Jul-2015 15-Jul-2015 Public Disclosure Copy Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P117417 IDA-47070 Effective XDR 44.82 44.82 0.00 7.09 37.73 16.00 P117417 IDA-H5570 Effective XDR 38.28 38.28 0.00 37.69 0.60 98.00 Disbursement Graph Key Decisions Regarding Implementation Public Disclosure Copy During the 2013 Joint Annual Review it was agreed that the FY2013/14 Annual Work Plan and Budget (AWPB) will prioritize : a) areas that are lagging (e.g. contraceptive prevalence rate, equity of access to quality services); and b) programs/activities that were dropped from the FY 2012/13 AWPB due to the reduction in budget. Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Page 7 of 7