Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) AFRICA EAST | Uganda | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 10 | ARCHIVED on 27-Jul-2021 | ISR47172 | Implementing Agencies: Ministry of Finance, Planning and Economic Development, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 04-Aug-2016 Effectiveness Date: 26-May-2017 Planned Mid Term Review Date: 23-Sep-2019 Actual Mid-Term Review Date: 09-Oct-2019 Original Closing Date: 30-Jun-2021 Revised Closing Date: 31-Dec-2022 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objectives (PDOs) are to: (a) improve utilization of essential health services with a focus on reproductive, maternal, newborn, child and adolescent health services in target districts; and (b) scale up birth and death registration services Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured)HRPDODELs The objectives of the Project are to: (a) improve utilization of essential health services with a focus on reproductive, maternal, newborn, child and adolescent health services in target Districts; (b) scale up birth and death registration services; and (c) to provide imediate and effective response to an eligible crisis or emergency Components Table Name Component 1: Results-Based Financing for Primary Health Care Services:(Cost $69.00 M) Component 2: Strengthen Health Systems to Deliver RMNCAH Services:(Cost $73.50 M) Component 3: Strengthen Capacity to Scale-up Delivery of Births and Deaths Registration Services:(Cost $10.00 M) Component 4: Enhance Institutional Capacity to Manage Project Supported Activities:(Cost $7.50 M) Component 5: Contingent Emergency Response Component:(Cost $20.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Substantial Substantial 7/27/2021 Page 1 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Implementation Status and Key Decisions The project continues to make steady progress towards attainment of the PDO. Annual targets on at least five of the nine PDO indicators have been achieved or are likely to be achieved. This could be attributed to improved implementation of project activities. Since the last health mission in October 2020, the major achievement has been on civil works where construction sites at all the targeted 81 health centers have been handed to contractors. Notable progress has also been made on Results-Based Financing, procurement and distribution of medicines and family planning commodities, clinical mentorship of health workers, and adolescent health. However, close follow-up will be required to avert negative effects of the second wave of the COVID-19 pandemic. Since the COVID-19 outbreak, Uganda has experienced significant disruptions in the provision of maternal and child health services. Given the resurgent of cases and new lockdown of 42 days, access to health services is likely to be disrupted further. The World Bank task team will continue working with the Ministry of Health to implement strategies to improve the resilience of the health system through Components 1 and 2 of the project. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Moderate Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and High Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Moderate Substantial Substantial Stakeholders Substantial Substantial Substantial Other -- Substantial Substantial Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improve utilization of essential health services with a focus on reproductive, maternal, newborn, ch IN01006362 ►Birth (deliveries) attended by skilled health personnel (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 59.00 51.60 75.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006365 7/27/2021 Page 2 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) ►Pregnant women who received IPT2 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 53.00 60.00 56.50 85.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006367 ►Couple Years of Protection (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2,196,713.00 3,835,235.00 3,875,183.00 4,200,000.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006368 ►Children under one year immunized with 3rd dose of pneumococcal conjugate vaccine (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 79.00 90.00 74.40 90.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006369 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 5,176,639.00 7,674,082.00 7,615,055.00 9,329,451.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006370 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1,027,305.00 648,994.00 1,232,649.00 1,522,902.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006371 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1,668,207.00 4,489,636.00 5,291,915.00 4,456,624.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006372 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 1,559,616.00 1,350,791.00 1,069,022.00 1,831,633.00 IN01006373 7/27/2021 Page 3 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 921,511.00 1,186,168.00 1,090,491.00 1,518,292.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 Scale up birth and death registration services IN01006363 ►Percentage of all deaths registered (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 2.00 2.00 10.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 The methodology for measuring this indicator has changed since Project inception. This explains the low proportion of registered births compared with the baseline figure. This indicator will be modified during Comments: restructuring and targets also changed. IN01006366 ►Percentage of births registered among children under 1 year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 13.00 18.80 15.00 50.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 This indicator will be modified during restructuring because of challenges in recording and registering Comments: deaths in Uganda. Strengthen disease outbreak preparedness and response IN01006361 ►Proportion of suspected COVID-19 cases that have undergone laboratory diagnosis and results provided within 72 hours of reporting. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 25.00 60.00 75.00 65.00 Date 01-Apr-2020 31-Dec-2020 30-Apr-2021 31-Mar-2021 IN01006364 ►Proportion of suspected EVD cases that have undergone laboratory diagnosis and results provided within 48 hours of reporting. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 55.00 100.00 100.00 100.00 Date 31-Dec-2019 31-Dec-2020 30-Apr-2021 31-Dec-2020 Overall Comments PDO 7/27/2021 Page 4 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Most of the indicators have been updated until quarter 3 of the financial year. Full year updates will be done in August 2021 when the Ministry of Health usually conducts data quality assessments and generate annual health sector performance reports. Intermediate Results Indicators by Components Component 1: Results-Based Financing for Primary Health Care Services IN01006374 ►Pregnant women receiving the first antenatal care within the 1st trimester (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 19.10 27.00 24.60 32.00 Date 30-Jun-2017 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006378 ►RBF health facilities with functional HUMCs with citizen representation (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 80.00 84.30 100.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006382 ►Health Center IVs offering caesarian section (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 81.00 68.20 80.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006385 ►Health facilities attaining at least 3 star rating under the RBF program (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 20.00 26.00 80.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006387 ►Clients expressing satisfaction with health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 25.00 25.00 31.00 35.00 Date 28-Jun-2019 01-Dec-2020 30-Apr-2021 30-Jun-2021 IN01006389 ►Proportion of Health Facilities that have 95% of the basket of essential commodities (RMNCAH) in the previous three months (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 52.00 46.00 47.00 55.00 7/27/2021 Page 5 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Date 30-Jun-2016 01-Dec-2020 30-Apr-2021 31-Dec-2022 Component 2: Strengthen Health Systems to Deliver RMNCAH Services IN01006375 ►Health facilities with placed orders that are fully filled by National Medical Stores (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 72.00 91.00 91.00 85.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006379 ►Health facilities constructed/renovated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 81.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 Civil works has not started so there is no current data. Comments: IN01006383 ►Health facilities equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 646.00 Date 28-Jun-2019 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006386 ►Health personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 814.00 814.00 1,040.00 Date 30-Jun-2015 01-Dec-2020 01-Dec-2020 31-Dec-2022 IN01006388 ►Approved posts in public facilities filled by qualified health workers (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.00 73.00 75.00 82.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006390 ►Districts providing ambulance and referral services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 81.00 131.00 131.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 7/27/2021 Page 6 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Component 3: Strengthen Capacity to Scale-up Delivery of Births and Deaths Registration Services IN01006376 ►Reported maternal deaths that are audited (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 33.00 66.00 61.00 69.00 Date 30-Jun-2015 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006380 ►Reported Perinatal deaths that are reviewed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.80 9.70 9.40 20.00 Date 28-Jun-2019 01-Dec-2020 30-Apr-2021 31-Dec-2022 IN01006384 ►Proportion of HC IVs using MVRS for Births and Deaths Notification (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 72.00 75.00 Date 28-Jun-2019 01-Dec-2020 30-Apr-2021 31-Dec-2022 Component 5: Contingent Emergency Response Component IN01006377 ►Percentage of designated Points of Entry (PoE) that are actively screening travelers for COVID-19 and viral hemorrhagic fevers (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 70.00 94.80 90.00 Date 31-Dec-2019 29-Jan-2021 30-Apr-2021 31-Mar-2021 IN01006381 ►Cumulative total number of tests done for investigating COVID-19 with GeneXpert and PCR tests (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 600,000.00 1,022,855.00 500,000.00 Date 27-Mar-2020 01-Dec-2020 30-Apr-2021 31-Mar-2021 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) 7/27/2021 Page 7 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P155186 IDA-58970 Effective USD 110.00 110.00 0.00 94.70 15.44 86% Not P174163 IDA-68000 USD 15.00 15.00 0.00 0.00 15.27 0% Effective P155186 TF-A2977 Effective USD 30.00 30.00 0.00 24.60 5.40 82% P155186 TF-A6713 Effective USD 19.54 19.54 0.00 19.43 0.11 99% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P155186 IDA-58970 Effective 04-Aug-2016 19-Jan-2017 26-May-2017 30-Jun-2021 31-Dec-2022 Not P174163 IDA-68000 02-Dec-2020 22-Jun-2021 -- 31-Dec-2022 31-Dec-2022 Effective P155186 TF-A2977 Effective 19-Jan-2017 19-Jan-2017 26-May-2017 30-Jun-2021 31-Dec-2022 P155186 TF-A6713 Effective 12-Sep-2018 16-Oct-2018 16-Oct-2018 30-Jun-2021 31-Dec-2022 Cumulative Disbursements Restructuring History There has been no restructuring to date. 7/27/2021 Page 8 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Related Project(s) P163691-Additional Financing Uganda Reproductive Maternal and Child Health Services Improvement Project ,P174163-Additional Financing for Uganda Reproductive, Maternal and Child Health Services Improvement Project 7/27/2021 Page 9 of 9