Report No: ICR00006587
IMPLEMENTATION COMPLETION AND RESULTS REPORT
CREDIT NO. 6374-LA
ON A
CREDIT IN THE AMOUNT OF SDR 19.6 MILLION
(US$ 27 MILLION EQUIVALENT)
TO THE
LAO PEOPLE’S DEMOCRATIC REPUBLIC
FOR
REDUCING RURAL POVERTY AND MALNUTRITION (P162565)
FEBRUARY 25, 2025
Social Protection & Jobs
East Asia And Pacific
The World Bank
Reducing Rural Poverty and Malnutrition Project (P162565) ICR DOCUMENT
CURRENCY EQUIVALENTS
(Exchange Rate Effective February 6, 2025)
Currency Unit = Lao Kip (LAK)
XDR 1 = US$1.30
LAK 21,734.41 = USD 1
FISCAL YEAR
January 1 - December 31
Regional Vice President: Manuela V. Ferro
Country Director: Mariam J. Sherman
Regional Director: Alberto Rodriguez
Practice Manager: Manuel Salazar
Kenichi Victor Nishikawa Chavez, Ali Winoto Subandoro,
Task Team Leader (s):
Yasuhiro Kawasoe
ICR Main Contributor: Jorge Avalos and Yashodhan Ghorpade
The World Bank
Reducing Rural Poverty and Malnutrition Project (P162565) ICR DOCUMENT
ABBREVIATIONS AND ACRONYMS
ANC Antenatal care
ASA Advisory Services and Analytics
CCT Conditional cash transfer
CPF Country Partnership Framework
DRDC Department of Rural Development and Cooperative
ECE Early Childhood Education
FM Financial Management
GoL Government of Lao PDR
HANSA Health and Nutrition Services Access Project
HGNDP Health Governance and Nutrition Development Project
IBM Iterative Beneficiary Monitoring
ICR Implementation Completion and Result Report
MAF Ministry of Agriculture and Forestry
M&E Monitoring and Evaluation
MIS Management Information System
MOH Ministry of Health
MOES Ministry of Education and Sport
MPI Ministry of Planning and Investment
NNC National Nutrition Committee
NNSPA National Nutrition Strategy and Plan of Action
PAD Project Appraisal Document
PEDIS Poverty Eradication and Development Information System
PDO Project Development Objective
PDR People’s Democratic Republic
PMT Proxy Means Test
PMU Project Management Unit
PRF Poverty Reduction Fund Project
SBCC Social and Behavior Change Communication
VF Village-Based Facilitator
WASH Scaling-up Water Supply, Sanitation and Hygiene Project
The World Bank
Reducing Rural Poverty and Malnutrition Project (P162565) ICR DOCUMENT
TABLE OF CONTENTS
DATA SHEET ................................................................................................................................................. i
I. PROJECT CONTEXT AND DEVELOPMENT OBJECTIVES ....................................................................................1
II. OUTCOME ...................................................................................................................................................5
III. KEY FACTORS AFFECTED IMPLEMENTATION AND OUTCOME................................................................... 10
IV. BANK PERFORMANCE, COMPLIANCE ISSUES, AND RISK TO DEVELOPMENT OUTCOME ............................ 11
V. LESSONS AND RECOMMENDATIONS .......................................................................................................... 15
ANNEX 1. RESULTS FRAMEWORK AND KEY OUTPUTS ........................................................................................ 18
ANNEX 2. BANK LENDING AND IMPLEMENTATION SUPPORT/SUPERVISION ....................................................... 24
ANNEX 3. PROJECT COST BY COMPONENT ......................................................................................................... 27
ANNEX 4. EFFICIENCY ANALYSIS ........................................................................................................................ 28
ANNEX 5. BORROWER, CO-FINANCIER AND OTHER PARTNER/STAKEHOLDER COMMENTS ................................. 29
The World Bank
Reducing Rural Poverty and Malnutrition Project (P162565) ICR DOCUMENT
DATA SHEET
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BASIC DATA
Product Information
Operation ID Operation Name
P162565 Reducing Rural Poverty and Malnutrition Project
Product Operation Short Name
Investment Project Financing (IPF) Reducing Rural Poverty & Malnutrition
Operation Status Approval Fiscal Year
Closed 2019
Original EA Category Current EA Category
Partial Assessment (B) (Restructuring Data Sheet - 31 Mar
Partial Assessment (B) (Approval package - 14 Mar 2019)
2024)
CLIENTS
Borrower/Recipient Implementing Agency
Lao People’s Democratic Republic Ministry of Agriculture and Forestry
DEVELOPMENT OBJECTIVE
Original Development Objective (Approved as part of Approval Package on 14-Mar-2019)
The Project Development Objective is to support the design and implementation of a nutrition-sensitive social assistance
program to improve nutrition behaviors, and enhance the convergence of nutrition-focused interventions.
s
s
s
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FINANCING
Financing Source Original Amount (US$) Revised Amount (US$) Actual Disbursed (US$)
World Bank Financing 27,000,000.00 22,452,226.03 23,475,699.59
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Reducing Rural Poverty and Malnutrition Project (P162565) ICR DOCUMENT
IDA-63740 27,000,000.00 22,452,226.03 23,475,699.59
Total 27,000,000.00 22,452,226.03 23,475,699.59
RESTRUCTURING AND/OR ADDITIONAL FINANCING
Amount Disbursed
Date(s) Type Key Revisions
(US$M)
• Components
• Results
22-Nov-2023 Portal 20.85
• Loan Cancellations
• Reallocations
• Loan Closing Date Extension
31-Mar-2024 Portal 23.04
• Reallocations
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KEY DATES
Key Events Planned Date Actual Date
Concept Review 24-Jan-2018 24-Jan-2018
Decision Review 25-Sep-2018 25-Sep-2018
Authorize Negotiations 13-Dec-2018 28-Nov-2018
Approval 14-Mar-2019 14-Mar-2019
Signing 09-May-2019
Effectiveness 26-Apr-2019 21-Jun-2019
ICR/NCO 27-Feb-2025 25-Feb-2025
Restructuring Sequence.01 Not Applicable 22-Nov-2023
Restructuring Sequence.02 Not Applicable 31-Mar-2024
ICR Sequence.01 (Final) -- 24-Feb-2025
Operation Closing/Cancellation 31-Aug-2024 31-Aug-2024
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RATINGS SUMMARY
Outcome Bank Performance M&E Quality
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Reducing Rural Poverty and Malnutrition Project (P162565) ICR DOCUMENT
Satisfactory Satisfactory High
ISR RATINGS
Actual Disbursements
No. Date ISR Archived DO Rating IP Rating
(US$M)
01 14-Jun-2019 Satisfactory Satisfactory 0.00
02 26-Dec-2019 Satisfactory Satisfactory 1.09
03 16-Jun-2020 Satisfactory Satisfactory 1.09
04 20-Dec-2020 Satisfactory Satisfactory 5.00
05 30-Jun-2021 Satisfactory Moderately Satisfactory 5.00
06 07-Jan-2022 Satisfactory Satisfactory 11.20
07 28-Jun-2022 Satisfactory Satisfactory 13.66
08 13-Jan-2023 Satisfactory Satisfactory 16.67
09 24-Aug-2023 Satisfactory Satisfactory 20.85
10 10-May-2024 Satisfactory Satisfactory 23.04
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SECTORS AND THEMES
Sectors
Adaptation
Mitigation
Major Sector Sector % Co-benefits
Co-benefits (%)
(%)
FY17 - Health FY17 - Health 10 0 0
FY17 - Information and FY17 - ICT Infrastructure 1 0 0
Communications
Technologies FY17 - ICT Services 3 0 0
FY17 - Public Administration - Social
27 0 0
FY17 - Social Protection Protection
FY17 - Social Protection 59 0 0
Themes
Major Theme Theme (Level 2) Theme (Level 3) %
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Reducing Rural Poverty and Malnutrition Project (P162565) ICR DOCUMENT
FY17 - Human
Development and FY17 - Nutrition and Food Security FY17 - Nutrition 89
Gender
FY17 - Private Sector
FY17 - ICT FY17 - ICT Solutions 38
Development
FY17 - Data production,
38
accessibility and use
FY17 - Public Sector FY17 - Data Development and
FY17 - Institutional
Management Capacity Building
strengthening and 38
capacity building
FY17 - Participation and
FY17 - Social Inclusion 89
FY17 - Social Civic Engagement
Development and FY17 - Social protection
38
Protection FY17 - Social Protection delivery systems
FY17 - Social Safety Nets 89
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Reducing Rural Poverty and Malnutrition Project (P162565) ICR DOCUMENT
ADM STAFF
Role At Approval At ICR
Practice Manager Philip O'Keefe Manuel Salazar
Regional Director Daniel Dulitzky Alberto Rodriguez
Global Director Michal J. Rutkowski Iffath Anwar Sharif
Practice Group Vice President Annette Dixon Mamta Murthi
Country Director Ellen A. Goldstein Mariam J. Sherman
Regional Vice President Victoria Kwakwa Manuela V. Ferro
ADM Responsible Team Leader Francesca Lamanna Kenichi Victor Nishikawa Chavez
Ali Winoto Subandoro, Yasuhiro
Co-Team Leader(s) Nkosinathi Vusizihlobo Mbuya
Kawasoe
ICR Main Contributors Jorge Avalos and Yashodhan Ghorpade
I. PROJECT CONTEXT AND DEVELOPMENT OBJECTIVES
A. CONTEXT AT APPRAISAL
Context
1. The RRPM was appraised in 2019, when Lao People’s Democratic Republic (PDR) had experienced strong
economic growth with low-to-moderate poverty reduction gains. Despite strong growth, poverty remained high.
Rural areas and ethnic groups faced high levels of poverty and had not benefited as fully as other groups from the
economic growth in the 2000s.1 Poverty incidence was 23.2 percent nationally, but it was 40 percent in rural areas
compared to 10 percent in urban areas. Poverty and human development indicators were also worse for ethnic
minorities, and in remote and highland areas in Northern Lao.
2. The persistence of high levels of childhood undernutrition represented considerable loss of human and
economic potential for Lao PDR, with significant geographic and income disparities. Stunting has long-term
adverse developmental impacts that far surpass childhood and has been linked to slower learning outcomes, poor
academic performance, and lower productivity and wages in adulthood. About 33 percent of children under five
years were stunted, 21 percent underweight, and 9 percent wasted according to the latest nationally
representative survey in 2017.2 The burden of high maternal and childhood malnutrition on the Lao PDR economy
was estimated to be at least $200 million annually, representing about 2.4 percent of the country’s GDP.
3. In Lao PDR, the key determinants of children undernutrition are multisectoral. These include: (i) women’s
limited access to health and nutrition services preventing them from receiving antenatal care services, (including
iron and folic acid supplementation and nutrition counseling), (ii) diet affordability and diversity, (only 55 percent
1 Gross Domestic Product (GDP) growth averaged 7.6 percent per year over the past decade and poverty declined from 33.5 percent to 23.2 percent
between 2002/03 and 2012/13 (RRPM PAD).
2 Lao Statistics Bureau. 2018. Lao Social Indicator Survey II 2017, Survey Findings Report. Vientiane, Lao PDR: Lao Statistics Bureau and UNICEF.
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of households in Lao PDR could afford a nutritious diet), 3 (iii) low coverage of basic sanitation (32 percent of
households practiced open defecation) and high prevalence of E. coli contamination (over 83 percent of
households) in water; and (iv) women’s socio economic status, agency and empowerment, or lack thereof.4
4. By project appraisal, the government of Laos (GoL) had placed an increased emphasis on reducing malnutrition.
This was evident in the promulgation of the 2016-2025 National Nutrition Strategy and Plan of Action (NNSPA).
Anchored in the 8th National Social Economic Development Strategy (NSEDP) 2016–2020, the NNSPA aimed at
accelerating the reduction of stunting in children under five years from 44 percent to 25 percent by 2025 using a
multisectoral convergence approach. The Ministry of Health (MOH), Ministry of Education and Sport (MOES),
Ministry of Planning and Investment (MPI), and the Ministry of Agriculture and Forestry (MAF) are the four leading
agencies in charge of implementing the strategy.
5. To support the Government’s efforts in tackling childhood stunting through multisectoral program, the World
Bank made a commitment to a multisectoral action plan. In 2019, in coordination with GoL, the World Bank
launched the Nutrition Convergence Program to tackle the multidimensional causes of undernutrition in Lao PDR
by optimizing operational and technical assistance commitments, as well as policy dialogue on nutrition, anchored
in a defined mechanism to lead multisector policy dialogue. It was agreed that nutrition-sensitive and nutrition-
specific interventions will be coordinated to the extent feasible in four key areas: (a) geographic convergence of
nutrition-specific and nutrition sensitive interventions in the same communities and households; (b) use of
common Social and Behavior Change Communication (SBCC) strategy, action plan, and tools; (c) leveraging of
each other’s delivery platforms, for example, pre-established community structures; and (d) using common
monitoring and evaluation (M&E) frameworks. The program targeted the most nutritionally vulnerable window
of opportunity, which is the first 1,000 days (period from conception to age two). This is also a period that is the
most crucial for the development of the child’s body, brain, metabolism, and immune system.
6. During its first phase, the nutrition convergence approach aimed to lay the institutional and operational
foundations for the multisector convergence before possible scale-up in subsequent phases.5 Five World Bank
operations were identified as nutrition-sensitive and were designed to maximize reductions in stunting prevalence
by working simultaneously in the same geographical areas and reaching the same households. The operations
include the RRPM; Health Governance and Nutrition Development Project (HGNDP; P151425); Health and
Nutrition Services Access Project (HANSA; P166165); Scaling-up Water Supply, Sanitation and Hygiene Project
(SWSHH: P164901); the Early Childhood Education (ECE; P145544); and Poverty Reduction Fund Project (PRF III;
P157963) and its additional financing (P168620). Each of these interventions aimed to address key causes of
undernutrition in Lao PDR such as access to health services (HGNDP, HANSA), feeding and caregiving resources
(RRPM, ECE), food security (PRF III), and safe and hygienic environment (SWSSH). The operations jointly
contributed to tackling the immediate and underlying causes of malnutrition in twelve priority districts in
provinces with the highest shares and absolute numbers of stunted children.
7. The social protection system in Lao PDR was nascent and did not explicitly address malnutrition. At project
appraisal, social protection programs, including social insurance, reached a small percentage of population6 and
none explicitly addressed child malnutrition. Furthermore, social protection policies and the underlying building
blocks of a social protection system to support poor and vulnerable households, including systems for
3 World Food Program (WFP) and Ministry of Health. 2017. Fill the Nutrient Gap Lao-PDR. Vientiane
4 Kamiya, Y., Nomura, M., Ogino, H. et al. Mothers’ autonomy and childhood stunting: evidence from semi-urban communities in Lao PDR. BMC
Women's Health 18, 70 (2018).
5 The World Bank-Lao PDR Phased Multisectoral Approach to reduced stunting runs from 2018 to 2028.
6 Only about 12 percent of the population was covered by any form of social protection, including social insurance. World Social Protection Report
2017–19: Universal social protection to achieve the Sustainable Development Goals International Labour Office – Geneva: ILO, 2017.
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identification, registration, payments, coordination, monitoring, or evaluation were underdeveloped or did not
exist. Social assistance programs were fragmented, small scale, and financed mainly by development partners.
Overall spending on social protection was about 1.7 percent of GDP (including pensions), far below neighboring
Viet Nam at 6.7 percent and the East Asia region average of 5.7 percent.
8. As part of the nutrition convergence approach, this project was designed to address the demand side
constraints that poor households face to access maternal and infant health and nutrition services. Implemented
by the Ministry of Agriculture and Forestry (MAF) whose mandate comprised rural development and poverty
reduction, this entailed: (i) addressing the low uptake of health and nutrition services known to contribute to
stunting reduction through conditional cash transfers (CCT) and targeted communication to parents (SBCC), (ii)
improving household nutrition practices through behavior change communication sessions; (iii) developing the
systems to deliver conditional cash transfers (social protection building blocks), and (iv) addressing the low
government capacity to coordinate, implement and monitor a multisector intervention. In this regard component
one supported the establishment of social protections building blocks; component two supported the design and
implementation of conditional cash transfers, and Component 3 the multisectoral coordination and monitoring
implemented by MPI.
Theory of Change (Results Chain)
9. The project employed three components to the achievement of the PDO target (Figure 1).
Figure 1. Results Chain
Project Development Objectives (PDOs)
10. The PDO was “to support the design and implementation of a nutrition-sensitive social assistance program to
improve nutrition behaviors, and enhance the convergence of nutrition-focused interventions.”
Key Expected Outcomes and Outcome Indicators
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11. The Results Framework and monitoring was framed with four PDO indicators and thirteen intermediate
results indicators. These included milestones such as the development of a social registry and progress in data
collection, as well as indicators of service delivery for the CCT program. Four PDO indicators measured the two
intended outcomes of the PDO: (a) Percentage of households with periodically updated socio-economic survey
information reported in the social registry, (b) number of beneficiaries of social safety net programs, (c)
percentage of children ages 6–23 months from cash transfer beneficiary households consuming foods from four
or more recommended food groups, measure the improvements in nutrition behaviors; and (d) number of
villages in project districts where at least three nutrition convergence projects have been implemented, tracked
geographical convergence of the nutrition focused interventions.
Components (Original US$; Actual US$)
Component 1: Developing the building blocks of a social protection system (US$3 million; US$3 million)
12. This component supported to develop a household targeting method, create a social registry, and create a
beneficiary registry. Specifically, the project financed (a) two rounds of data collection for a social registry,
including hiring and training of staff, and logistical and administrative costs; (b) a management information
system (MIS) for the social registry; (c) development and operationalization of a targeting method; (d)
establishment of an integrated beneficiary registry.
Component 2: Conditional cash transfer program (US$16.70 million; US$13.57 million)
13. This component supported setting up and delivering a CCT program. The goals of the CCT program were to
incentivize nutrition-promoting behaviors such as improving dietary quality (diversity and amount), increase the
utilization of essential health and nutrition services, and contribute to poverty reduction in targeted areas. The
benefit value was set at LAK 180,000 per individual beneficiary per month (around US$19 in 2021), which was
about 14 percent of household consumption for the poor. This component financed activities across three
subcomponents. Subcomponent 2.1 supported the development of the delivery mechanism, including (a) MIS
to support implementation and monitoring; (b) an effective system to enroll eligible households; (c) a system
for delivery of secure and timely cash payments; and (d) a system for grievance redress. Subcomponent 2.2
financed cash transfer benefits to households with pregnant women and children under age two and the service
fee of a third-party payment provider. Subcomponent 2.3, which required close collaboration with MOH, and
other nutrition convergence projects, supported the development of new SBCC modules, innovative audio-
visuals tools to deliver these, and allowance paid to Village-based Facilitators (VFs).
Component 3: Coordination, management, monitoring, and evaluation (US$7.30 million; US$7.30 million)
14. This component financed project management and coordination, monitoring, and evaluation of the multisector
nutrition convergence approach through two subcomponents. Subcomponent 3.1 supported (a) staff costs for
day-to-day implementation in MAF (communication, procurement, financial management, safeguards
management, and coordination of the project), (b) training, (c) operational costs, and (d) implementation of key
process monitoring tools of the CCT program. Subcomponent 3.2 supported multisectoral coordination efforts of
the MPI, through (a) the development of guidelines for planning and coordination, (b) training and operational
costs for the execution of the coordination, development, and implementation of M&E functions, (c) surveys and
citizen engagement activities to assess operational effectiveness and impact of the convergence approach. This
subcomponent supported an M&E system for the multi-sectoral convergence approach through five tools7 and
financed the evaluation of the convergence approach.
B. SIGNIFICANT CHANGES DURING IMPLEMENTATION (IF APPLICABLE)
7 Village score cards, iterative beneficiary monitoring (IBM), administrative data (sector and convergence projects’ MIS), spot checks, and key
informant interviews.
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15. The project was restructured two times. The first restructuring, in September 2023, cancelled project funds
(Category 2 cash transfers) under component 2 (SDR 2,382,686.95, equivalent to US$3,129,301) and revised the
intermediate indicator thirteen. This cancelation was necessary given that the CCT program was delayed due to field
restrictions caused by COVID-19 pandemic in 2020. The project started field enrollment and payment in March 2021,
(instead of March 2020 as was initially planned). The second project restructuring, in March 2024, extended the
project closing date from March 31, 2024, to August 31, 2024, to ensure the full use of savings in cash transfers
(approximately US$960,000)8 for two additional cash transfer cycles (April-May and June- July) to be paid to about
22,000 beneficiaries. The second restructuring also included a reallocation of US$1,101,486 from Expenditure
Category 2 to Expenditure Category 1 due to a projected overrun of Category 1 expenses. The project costs by
component at approval and actual disbursements are in Annex 3. Cancellation and reallocation of project funds had
no impact on the PDO, which was fully achieved.9
II. OUTCOME
A. RELEVANCE OF PDO
Rating: High
16. The PDO was highly relevant to the Government’s development agenda and the World Bank’s multisectoral
nutrition strategy at appraisal and remained relevant during implementation.
i) Relevance to the GoL objectives. The project responded to the GoL’s efforts to accelerate the reduction of stunting
in children under five years. The project helped establishing the coordination and oversight mechanism for
multisectoral program supported by a robust monitoring system. The project implementation provides a learning
experience for the GOL in operationalizing a convergence approach coordinated by an oversight agency, such as
MPI. The project also supported the National Social Protection Strategy – Vision 2030, adopted in 2020, aiming to
expand and improve social protection and contribute to human capital development. The project was successful in
establishing key building blocks for Social Protection and improving nutrition convergence, key tools to support the
development of human capital and poverty reduction as outlined in the 8th National Social Economic Development
Strategy (NSEDP) 2016–2020, and further articulated in the 9th NSEDP 2021-2025. The nutrition convergence
program was included as one of the key commitments delivered by the Prime Minister at the 2nd Human Capital
Summit in June 2024. Furthermore, the positive impact of the CCT in combination with other nutrition convergence
interventions has served as evidenced to inform policy, as the NPAN 2021-2025 include social protection and the
CCT as key elements of the government vision to combating malnutrition.
ii) Relevance to the Country Partnership Strategy/Country Partnership Framework objectives. The World Bank
supported the GoL in its efforts to improving nutrition to achieve children’s full potential and building resilience
and mitigating risks, which are anchored in the ‘Building Assets of People’ Pathway of the Country Partnership
Strategy (CPF) 2017 (Report No. 112241-LA).10 In the Country Partnership Framework (CPF) for FY17–FY22 (Report
No. 110813-LA), 11 the project supported Focus Area ‘Investing in People’ and Objective 2.1 and 2.4 to reduce
malnutrition and reducing vulnerability and inclusive access to social services. The CPF FY2023-2026 (Report No.
177311-LA) continued the focus areas of the previous CPF on reducing malnutrition and improving access to and
quality of maternal and child health services, through Objective 5 on expanding use among women and children of
practices and services beneficial to nutrition.
8 Savings originated due to the significant depreciation of the Lao Kip vis a vis the US Dollar that set in a few months after the beginning of the CCT
program and continued thereafter.
9 For instance, while the periods of benefit payment were shorter for some beneficiaries, the number of enrolled CCT beneficiaries was surpassed.
10 Lao PDR: Systematic Country Diagnostic 2017. March 9, 2017.
11 Laos - Country partnership framework for the period FY2017-FY2021. Washington, D.C. World Bank Group.
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B. ACHIEVEMENT OF PDOs (EFFICACY)
Rating: Substantial
17. The efficacy of PDO achievement is Substantial. The PDO sought to achieve two project level outcomes – to
enhance nutrition behaviors and to enhance nutrition convergence. With regard to enhancing nutrition behaviors,
the project successfully supported the development and implementation of the CCT and developed and rolled out
four new SBCC modules that improved nutrition behaviors. The CCT contributed to better nutritional outcomes by
increasing the affordability of nutritious food and stimulated the increased demand for and utilization of essential
health and nutrition services known to improve nutritional outcomes. Despite a slow progress at the beginning, the
project enhanced nutrition convergence through the development of guidelines and funding of coordination
meetings and capacity building for the nutrition committees at national, provincial, and district levels. It also
incentivized the co-location of complementary health services, cash transfers, and livelihood activities to enable
beneficiaries to access services and food resulting in significant impact in mitigating stunting during the project.
These activities were supported by a set of monitoring tools developed to track convergence objectives.
18. The project was successful in achieving three of the four PDO indicators, exceeding their end target values. While
PDOs 1, 2 and 4 were fully achieved, the final value for PDO 3 was slightly lower than the target. However, the
midline survey12 showed that a larger share of CCT children 6-23 months were consuming foods from four or more
food groups (37 percent) compared to children who did not receive the program until later (30 percent) due to the
phased-in approach to enrollment to accommodate the impact evaluation design.
Table 1. PDO Indicators
Target
PDO Indicators Baseline Achieved Value
Value
1. Households with periodically updated socio-economic information in the
0 80 100
social registry (percentage)
2. Beneficiaries of social safety net program (number) 42,743 49,536
0
Beneficiaries of social safety net program - Female 38,460 47,799
3. CCT children 6-23 months consuming foods from four or more Not
40 37
recommended food groups (percentage) Recorded
4. Target villages where at least three nutrition convergence projects have
0 528 544
been implemented (number)
Almost all intermediate indicators were achieved, and many of them were significantly surpassed. One
exception was the “percentage of cash transfer reaching target areas within five days of scheduled payment date.”
Frequent and timely delivery of benefits were sometimes challenging due to bottlenecks in finalizing beneficiary
payrolls at different level of government (district, province, and central) and in payment reconciliation. The project
has addressed the challenge by promoting digital payment and improving communication with beneficiaries, while
it remains as a challenge to be addressed in the subsequent project (RRPMII).
Table 2. Intermediate Results Indicators
Intermediate Results Indicator Baseline Target Achieved
Value Value
Component 1: Developing the building blocks of a social protection system
Development of a social registry No Yes Yes
12Data source for PDO 3 was the endline impact evaluation survey. However, the endline survey was postponed to RRPM II and as a result the midline
survey is used to provide estimates.
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Percentage of households surveyed with the PMT questionnaire in target areas (percentage) 0 90 100
Component 2: Conditional cash transfer program
Percentage of project beneficiary households who participate in community nutrition
0 90 98
sessions at least once per month. (Percentage)
Percentage of cash transfers reaching target areas within 5 days of scheduled payment date.
0 80 36
(Percentage)
Percentage of children under 2 years from cash transfer beneficiary households receiving
growth monitoring and promotion services according to the standard monitoring schedule. 0 40 97
(Percentage)
Number of female village facilitators trained to use new SBCC tools. (Number) 0 1,600 2,117
Percentage of grievances addressed and/or resolved within the stipulated service standards
0 90 98
for response times. (Percentage)
Percentage of female direct cash transfer recipients who report increased decision-making
0 90 97
power on spending decisions for the household. (Percentage)
Percentage of pregnant women from cash transfer beneficiary households with at least 4
0 60 94
ANC contacts during their pregnancy (Percentage)
Component 3: Coordination, management, monitoring, and evaluation
Number of spot checks implemented (Number) 0 3 3
Percentage of project districts convening a multisectoral nutrition coordination meeting at
0 90 100
least once every three months (percentage)
Percentage of cash transfer monthly reports generated in a timely manner (Percentage) 0 90 100
Number of cross-sectoral surveys carried out to evaluate different convergence
0 2 2
interventions. (Number)
19. Beyond the indicators, evidence based on the impact evaluation shows positive impact of the CCT and nutrition
convergence. The CCT program effectively improved selected nutrition outcomes (i.e., the CCT reduced wasting in
children under two years old by 4.2 percentage point), and dietary quality (increased the share of children 6 –23
months old consuming foods from four or more recommended food groups by 10.7 percentage points). Further, the
evaluation found that stunting and wasting among children under two years old would have been 7.7 percentage
points and 3.4 percentage points higher, respectively, if the convergence interventions had not been put in place
before the onset of COVID-19.13 Child dietary diversity and household diversity among the targeted beneficiaries also
increased by 12.7 percent and 6.6 percent, respectively. Other stakeholders have also noticed the impact of the
program, for instance, health care staff mention that immunization increased among non-Lao Tai ethnic groups
known for traditional reluctance towards vaccination.
20. Furthermore, as a result of the project, Lao PDR now has a comprehensive national social registry, with high
population coverage, which is regularly updated and used by several social programs. As envisaged in the PAD, the
social registry was first successfully developed and tested in four project provinces in 2020. Upon satisfactory rollout,
in 2022 the GOL requested to extend financing nationwide to all provinces, representing a breakthrough in the
information management of the Decree 348 Poverty data relative to the pre-project situation. Two rounds of data
collection were conducted in 2020 and 2022/2023,14 and regular updating is conducted to keep data accurate in
project provinces. The registry includes 6.5 million individuals residing in 8,402 villages across 148 districts in eighteen
provinces resulting in coverage of 85 percent of the population. The social registry and the introduction of the
targeting method of social protection programs, play a significant role in implementing the Government’s nutrition
13 Results show that the interaction of the PRF and CCT, in addition to health supply and SBCC provided through HANSA, improved anthropometric
measurements in children under two and five years old. The WASH intervention was not part of the impact evaluation due to late rollout.
14 RRPM financed data collection in four target provinces in the first round (2020). For the second round in 2022/23, the project financed partly the
nationwide data collection (i.e., enumerator training and logistic costs).
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convergence approach and is also used by development partners to plan and deliver interventions. Currently, the
CCT and PRF interventions at MAF, and the subsidized health insurance program at MOH and four development
partners have used the social registry for planning and implementation of programs.15
Justification of Overall Efficacy Rating
21. The overall Efficacy rating is Substantial. Three PDO indicators and all intermediate indicators were achieved (and the
fourth PDO reached over 90% of the target value), and some of them significantly surpassed end target values.
C. EFFICIENCY
Rating: Substantial
22. Project investments generated substantial efficiencies, though not all can be quantified. While it will take time to
realize the full potential benefits of the project investments, the modernization of the administration of poverty data
(under Decree 348) and the development of the CCT resulted in efficiency gains across several dimensions, this include:
(i) establishment of a social registry to modernize Decree 348 Poverty data administration and management improved
efficiency for administrators and beneficiaries, and (ii) although the cost-effectiveness of the CCT program was modest
given the large initial costs, the program became a key contributor to addressing stunting and supported poor
households during periods of high inflation.
23. The cost efficiencies generated by the Social Registry outweighs the costs of developing and operating the system
over time. The cost of developing the Social Registry is reasonable in relation to the volume of beneficiaries it can
serve and is comparable internationally. The estimated cost at US$1.6 per household16 is minor relative to the savings
generated by improved administration of data. 17 As a comparison, Türkiye’s Integrated system cost US$1.3 per
household, excluding training cost. Some of these cost efficiencies include reducing paper and storage costs across all
districts in the country; identifying objectively potential beneficiaries for social protection and disaster response
programs;18 preventing, detecting, and remedying data collection errors; and reducing processing time and cost for
monitoring and reporting. It is expected that overall and over time resource savings are substantially higher than the
US$3 million invested in hardware, designing, and developing the system, and providing training to operate it.
Table 3: Cost breakdown for the Social Registry
Item Amount (US$)
Design and development of database and MIS 766,000
Computers and other hardware 632,340
Training and technical support19 1,380,000
Data collection (per diem and logistics)20 675,100
Total 3,453,440
24. Although the CCT program required large initial investments to set up, efficiency gains will be possible in the
medium- and long-term. The cost-effectiveness analysis shows that the CCT program led to a 0.03 percentage point
reduction in stunting per US$100 spent (or a cost of US$4,430 per case of child stunting averted). The Cost
15 These include Asian Development Bank, the Food and Agriculture Organization of the United Nations, World Food Program, and the United States
Agency for International Development.
16 Estimate based on the costs to establish the social registry and conduct data collection (except training), and the 1.2 million households enumerated.
17 Estimating cost efficiency of the SR presents a challenge given that estimating and comparing registries is not straightforward. Registries incur
different types of administrative costs, and the costs are spread out over time.
18 Potential beneficiaries may have been left out without the development of the Social Registry.
19 Technical support includes hiring of IT officers at central and provincial level during project implementation.
20 Data collection expenses for two rounds of data collection.
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Effectiveness Analysis (CEA) estimate for the CCT is probably an underestimation of the cost-effectiveness of the
program given that program’s impact is only measured over two years, but costs are included for goods that can
continue to be used over many more years. The CEA estimate does not exclude costs that may overlap with other
programs in the future (e.g., new programs utilizing the Social Registry and targeting method to identify
beneficiaries). Moreover, the CCTs aim to achieve objectives other than reducing malnutrition. CEA estimates for the
CCT over a longer period are more favorable as they suggest greater cost-effectiveness due to the lower
administrative cost of implementing the program and an expected higher significant impact on stunting.21
D. JUSTIFICATION OF OVERALL OUTCOME RATING
25. The overall rating is Satisfactory based on its High relevance, Substantial efficacy, and Substantial efficiency.
26. The relevance of the project design is rated high. The development objective of the project was and remains highly
relevant to Lao PDR development priorities. High relevance rating reflects appropriate activities to develop SP
building blocks, a conditional cash transfer program, and improving convergence coordination by supporting the
complimentary delivery of health, cash transfers, and livelihood programs.
27. Efficacy is rated Substantial. Achievement of the objective to enhance nutrition behaviors is rated Substantial,
particularly regarding the implementation of the nutrition-sensitive CCT, which employed an objective targeting
mechanism, and continued actively searching and enrolling new pregnant women throughout the project
implementation. Achievement of the objective in enhancing nutrition convergence is rated Substantial. Most target
villages received at least three nutrition specific or nutrition-sensitive interventions resulting in statistically significant
impacts to mitigate stunting and, with some challenges in implementation, monitoring tools tracked and informed
convergence activities effectively.
28. Efficiency is rated Substantial. Over time, the cost efficiencies that were generated by the social registry will
outweigh the costs of developing and operating the system. Likewise, the initial investments in service delivery of
the CCT and capacity will be more cost-effective as the program scales up in urban and peri-urban areas and the
proportion of administrative to transfer costs (the amount of money transferred to families who have met the
program conditions) decreases further.
E. OTHER OUTCOMES AND IMPACTS (IF ANY)
Gender
29. The project targeted the most vulnerable population group – poor ethnic women – and activities were gender
informed. The project supported a gender-sensitive intervention by targeting pregnant women and providing
benefits directly to women. The CCT program selected women as recipients of the cash benefits (96 percent of
benefit recipient were women) with the objective to improving women’s decision-making power on spending
decisions within the household. Results from the impact evaluation show that 97 percent of beneficiary women
have improved their decision-making power in their household. This can be attributed to the communications and
information activities conducted during enrollment and the SBCC sessions. The project also considered gender-
sensitive factors to select CCT frontliners. More than half of CCT frontliners and Village Facilitators were ethnic
women, which created favorable conditions for participation in the program activities (e.g., facilitating
communication in local ethnic languages). Finally, the MIS allows all indicators to be disaggregated by gender.
Institutional Strengthening
21Excluding convergence and M&E activities, transfer cost represents nearly half of project financing (48 percent), followed by administrative cost (35
percent) and targeting (17 percent).
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30. The project built the capacity of MAF and MPI staff responsible for the project operations at central and local
offices. Throughout implementation, capacity-building activities were continuously implemented with an
emphasis on transferring knowledge to operate the MIS, improve payment and grievance redress systems, and
generally seeking to improve the business processes of the CCT and M&E for convergence. Despite some
challenges at the beginning of the implementation, the project established regular coordination meetings at
national, province and district level that brings different sectors to discuss services relevant to nutrition
improvement. Furthermore, the World Bank team organized study tours for government counterparts to visit
countries that operate interventions like the CCT. Key activities such as trainings, support to develop operational
manuals, communication strategies, and M&E carried out during project implementation helped build
institutional capacity for social protection and nutrition convergence coordination.
Poverty Reduction and Shared Prosperity
31. The interventions financed by the project are expected to contribute to sustained impact of the social
protection system on poverty reduction in the medium to long term. During the outbreak of the COVID-19 and
during periods of high inflation, the GOL was able to provide income support to poor and vulnerable households
beneficiaries. This economic support mitigated the deepening of poverty in target areas. Moreover, the strong
focus on the poor and ethnic groups (non-Lao Tai made about 85 percent of all CCT beneficiaries) through rigorous
targeting method further emphasized the project’s focus on supporting the poorest households within target
areas.
III. KEY FACTORS AFFECTED IMPLEMENTATION AND OUTCOME
A. KEY FACTORS DURING PREPARATION
32. A critical factor affecting implementation at the preparation stage of the project was the ex-ante coordination of
various World Bank projects to co-locate their interventions in target areas. The dialogue on nutrition and
coordinated approach for rolling out interventions in the same target areas was influenced by the emerging
evidence from countries tackling stunting in a convergent manner, strong analytical work in Laos,22 and the nudging
of the Country Management Unit (CMU) which facilitated coordination among relevant Global Practices (GPs to co-
locate their pipeline projects). Furthermore, coordination with other development partners interventions (e.g.,
Agriculture for Nutrition funded by the International Fund for Agricultural Development) ensured synergies while
avoiding the implementation of similar interventions in the same geographic areas.
B. KEY FACTORS DURING IMPLEMENTATION
33. During implementation, the active involvement of local stakeholders and continuous support of the central level
government agencies such as MAF and MPI were important factors. Key activities which brough together central
and local level stakeholders were the annual and semi-annual project and nutrition convergence coordination
meetings at national, province and district level, which increased awareness of the CCT and nutrition convergence
activities, gained local level support for project activities, and discussed implementation issues and challenges. At
the village level, Village Nutrition Day, a designated day in each village where convergence interventions deploy
their activities in a coordinated manner, 23 helped demonstrate the importance of village level convergence
activities. Further the implementation of the CCT and nutrition convergence activities required the creation of village
CCT sub-committees by MAF through ministerial regulation.24 Through the issuance of this circular/decree, the sub-
committee supported implementation by establishing communication channels to raise awareness and provide
22 Osornprasop, Sutayut; Pimhidzai, Obert. Nutrition in Lao PDR: causes, determinants, and bottlenecks (English). Washington, D.C.: World Bank Group.
23 The Village Nutrition Day was piloted in sixty villages across the twelve target districts.
24 MPI employed the CCT coordinator as the Nutrition Convergence coordinator in most target villages.
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information about the CCT to villagers, provide updates on the status of program activities, monitor beneficiaries,
and collect feedback and complaints from the community.
34. The COVID-19 disruptions and inflation created important challenges in implementation. The COVID-19
disruptions created difficulties to carry out project operations in the field and delayed project rollout by one year.
For the CCT implementation, this resulted in limited in-person training of CCT staff at province and district level,
difficulties to enroll eligible pregnant and children under two years on time, and ultimately a shorter time for CCT
implementation. This in turn meant that cash transfers under Category 2 funds were not fully utilized. For
convergence activities, the COVID-19 disruptions postponed quarterly district meetings, and resulted in cancellation
of in-person supervision and monitoring activities. Moreover, high levels of inflation affected Laos during project
implementation, the main challenges were related to access to fuel to conduct registration and updates to the social
registry and monitoring activities.
35. Joint activities undertaken by MAF and MPI often required lengthy coordination which resulted in considerable
delay. Project activities were undertaken primarily by the Project Management Unit (PMU) under the MAF.
However, some activities, such as monitoring of convergence program, were under the purview of MPI. Agreeing
on scope of work, activity costs, and budget management took time and resulted in some delays which had
subsequent implications on project implementation.
36. Cross-project coordination was a challenge in implementing some nutrition convergence activities, especially at
the beginning of the project implementation. While co-location of projects was achieved, inter-program
coordination took some time to be effective. It was not until early 2023 that MPI played a larger coordinating role
across programs. Initially, the coordination meetings focused on sharing information with limited use of monitoring
data to improve implementation. Technical support and cross-country learning helped building MPI capacity to
perform effective coordination function. While MPI has been able to continue this role in the RRPM II, the lessons
learned from early implementation experiences were useful in improving the coordination mechanism in RRPM II.
The coordination on SBCC and delivery platforms also proved to be challenging. Each convergence project developed
their SBCC modules, however, leveraging their respective delivery platforms using pre-established community
structures proved to be a challenge. Under each project, different delivery platforms involved project specific
frontline workers, however only HANSA and RRPM collaborated and used the same VFs to support the CCT and SBCC
delivery. Coordination to deliver SBCC topics could have been better as beneficiaries reported receiving repetitive
SBCC content over a short period of time.25
37. Project staff turnover affected project activities at the central level for implementation of the CCT. Although the
PMU remained well staffed during project implementation, key roles for social and communication positions were
vacant for an extended period. Provincial and district level turnover was less affected. By design, most provinces
and district level teams housed appropriate number of project consultants on key positions (IT, management, and
monitoring). Local staff had to take on additional tasks while also having to carry out their project activities.
IV. BANK PERFORMANCE, COMPLIANCE ISSUES, AND RISK TO DEVELOPMENT OUTCOME
A. QUALITY OF MONITORING AND EVALUATION (M&E)
M&E Design
38. A comprehensive M&E plan was designed to monitor the implementation and impact of the multisectoral nutrition
convergence approach. An M&E framework was designed to track the convergence of nutrition interventions at the
village level, report on nutrition indicators, and quantify the impact of the convergence approach. The framework
outlined indicators, tools, information sources, timing, responsibilities, and reporting. Five main tools were developed
25 Feedback received during ICR interviews with beneficiaries.
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to monitor the delivery of interventions of the convergence approach: village score cards, iterative beneficiary
monitoring (IBM), administrative records from project MIS, spot checks, and key informant interviews. The impact
evaluation design leveraged the staggered rollout of the different projects in convergence districts, allowing for
embedding an experimental impact evaluation design. Three impact evaluation surveys were anticipated to be
deployed, corresponding to the baseline, midline, and end line of the convergence approach implementation. Lao is
among a very few countries (aside from Rwanda and Cambodia) that has robust impact evaluation design for
multisectoral convergence program, providing significant contribution to generating credible evidence on the effects
of multisectoral program in addressing malnutrition.
39. All the M&E activities and surveys, except the end-line evaluation, were completed within the project
implementation timeline. Village score cards served its purpose of reporting on interventions being delivered in each
of the target villages. A total of eight surveys, five IBMs and three spot checks, were planned to be deployed to track
implementation of activities and assess beneficiary perception and participation in program activities. Spot checks
were used to validate if projects are functioning as intended and to troubleshoot problems related to the program’s
processes. For instance, the spot checks assessed whether CCT beneficiaries were complying with the requirements
of the CCT program and receiving grants on time. The programs’ MIS served its purpo se as a monitoring tool.
Specifically, the social registry and the program MIS, known as Poverty Eradication and Development Information
System (PEDIS)26 established at MAF, provided regular administrative reporting about implementation of convergence
interventions and CCT-specific output, providing stakeholders the ability to extract relevant data, as needed. Key
informant interviews were also conducted to have an in-depth understanding of project actors (i.e., community
mobilizers, village facilitators, district convergence committee) perspectives on implementation process. Moreover,
a process evaluation towards the end of the project was completed to examine the business processes of the CCT
program.
40. Rather than conducting the end-line evaluation survey in December 2023, it was decided that it would be more
valuable to conduct the evaluation by early 2025, after the project’s completion. To assess the impact of the
nutrition convergence approach, a baseline survey was conducted in October 2020 and a midline survey in November
2022. Originally, the endline survey was planned for December 2023. However, considering the proximity between
midline and endline surveys, the potential impact on utilization and outcomes of nutrition and health services was
likely limited. Instead, it was decided to provide allow more time in between evaluation surveys and to use the mid-
line evaluation results to report on PDO indicator 3.
M&E Utilization
41. The M&E results informed decisions and adjustments throughout project implementation. Monitoring tools
provided information about implementation issues of the convergence interventions, including convergence at the
village level, and feedback from beneficiaries about activities introduced by the projects. Although with some delay,
the government was able to use some of the findings to inform implementation. For example, corrective measures
were taken after program implementers received feedback that value of the CCT benefit had eroded due to inflation.27
IBMs and spot checks identified issues in enrollment procedures for CCT beneficiaries (lack of identification and
supporting documents), challenges of CCT frontliners in their role of providing information about the projects’
features and nutrition knowledge (that is, challenges to provide appropriate nutrition advice and referral to health
centers), and low awareness of activities to improve gender relations, which the government tried to address.
Furthermore, the baseline and mid-line surveys presented key characteristics and trends of beneficiaries and non-
beneficiaries and assessed the impact of the convergence strategy. Although, the M&E findings were valuable for
26 Access through the following domain: https://pedis.maf.gov.la.
27Until then the value of the grant had not been adjusted, despite inflation, but corrective action entailed modest upward revisions of
the benefit amount.
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improving implementation and assessing impact, better dissemination and follow-up on corrective actions could have
maximized the utilization of M&E results.
Justification of Overall Rating of Quality of M&E
42. M&E is rated Substantial. An M&E system was embedded from the project design stage to track the performance of
convergence projects’ activities and the programs it supported. The project benefited from rich quantitative and
qualitative feedback collected from beneficiaries, frontliners, and local government officers. Importantly, the
evaluation findings provide valuable information and served as key evidence to continuing supporting the convergence
approach and expanding it to other provinces.
B. ENVIRONMENTAL, SOCIAL, AND FIDUCIARY COMPLIANCE
43. Environment. The project Environmental Assessment Category is B-Partial Assessment. Environmental Assessment
(OP/BP 4.01) was triggered at project appraisal due to its potential socioeconomic impact on vulnerable groups.
Given the nature of project activities and locations, there was no activity with potential adverse risks and impacts
on the environment. The environmental performance was rated satisfactory for most of the implementation period.
The project environmental risk at the ICR is low.
44. Social. Throughout implementation, the project worked towards inclusion of ethnic groups as well as gender and
cultural sensitivity. The project prepared and used key elements of the Social Assessment into the overall project
design and implemented appropriately (for example, consultations with non-Lao Lum ethnic groups and information
dissemination in ethnic minority languages). Project activities tried to address cultural and language challenges by
hiring local frontliners and providing training and in-time technical assistance on gender and inclusion of non-Lao
Lum ethnic groups. Delivery of benefits to each village through an independent payment provider gave accessibility
to all beneficiaries, including non-Lao Lum ethnic group beneficiaries living in remote villages. Focal persons were
assigned to support the mainstreaming of gender and ethnic groups in operational information systems, operations
manual, and social marketing. Moreover, the tracking and reporting of the CCT systems, including the grievance
redress mechanism, enabled using sex- and ethnicity-disaggregated data.
45. Financial management (FM). At appraisal, the project FM risk rating was High. MAF FM capacity, experienced FM
staff, systems, and documented procedures, were considered relatively weak for implementing a CCT program,
given the project complexity and geographic spread. The following actions were agreed upon to mitigate the risks:
(a) developed an operations manual and update existing FM manuals to be tailored for CCT payouts; (b) assign FM
personnel for the project and complement with FM consultants; (c) use Complete and Comprehensive Program for
Accounting Control (ACCPAC) software; (d)provide training to staff; (e) prepare an annual budget and work plan to
be approved by the World Bank; (f) conduct annual audits by an independent firm; and (g) prepare and submit
quarterly IFRs to IDA no later than 45 days after the quarter ends.
46. During implementation, lack of FM capacity, affected project implementation. FM arrangements and maintenance
of accounting records were a challenge during implementation. Although, the World Bank team provided FM
training to project consultants, operational issues such as delays in payment processing and payout and liquidation,
delay in submitting documentation of incurred expenditure, and overall poor maintenance of accounting records
limited better accounting, planning, and use of funds. In some instances, CCT payment periods were combined and
delivered late. Furthermore, coordination with regards to FM between MAF and MPI were also challenging. Funds
allocated for MPI were used for conducting MAF-related activities leaving limited funds for executing monitoring
tools. As a result, the FM rating remained Moderately Satisfactory until project completion.
47. Procurement: At appraisal, the project procurement risk was rated Moderate based on the capacity in implementing
World Bank procurement rules and procedures and risk assessment carried out in June 2018. During
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implementation, PMU adopted the project operational manual (POM) including a detailed procurement section.
The PMU recruited qualified procurement consultants to manage procurement activities. The World Bank team
provided training to the PMU on procurement rules and procedures and provided hands-on support on request.
Despite minor delays, the PMU effectively used the POM, procurement training was provided to staff, and there
was assistance to procurement consultants who were recruited to accelerate and keep the project implementation
progress on track. Therefore, the overall procurement performance maintained a “Satisfactory” for most of the
project duration.
C. BANK PERFORMANCE
Quality at Entry
48. The World Bank team actively engaged in policy dialogue and TA in nutrition in Laos, which became instrumental
in developing the project. During preparation, the World Bank team facilitated partnership among MAF and MPI and
provided technical assistance. The Advisory Services and Analytics (ASA) on social protection and on nutrition
(P160711, P165482) contributed to the policy dialogue on social assistance and helped developed a common M&E
framework for nutrition convergence. The project preparation team ensured that the project design was relevant
and met the GOL’s development priorities and the World Bank’s CPF at the time. The operation is built on
international evidence which shows that efforts to accelerate stunting prevention are more effective if nutrition-
specific and -sensitive interventions are implemented in a convergent manner. CMU encouraged collaboration across
relevant GPs to identify opportunities for co-locating the project areas. The project design also took into
consideration the recommendations from peer reviewers, and lessons learned from other World Bank- and donor-
supported projects. The project was subject to a quality enhancement review process and the preparation team
identified the appropriate risks and incorporated design features to mitigate them. Based on this, the quality at entry
is rated Satisfactory.
Quality of Supervision
49. The World Bank team provided strong and proactive support to MAF and MPI throughout project implementation.
The World Bank team conducted regular implementation support missions, including a midterm review, and this was
supplemented by interim technical support missions as needed. The World Bank team reported the project progress
toward achieving its objectives, and progress by each component, performance on fiduciary management,
compliance with safeguards, and kept the government counterparts and the World Bank management informed of
progress and key issues. ASA resources were used to provide TA for activities related to CCT and nutrition
convergence. A major supervision challenge was the travel restrictions due to the COVID-19 pandemic. The World
Bank team was not able to provide direct support to the PMU when it wanted to initiate the social register survey
and CCT for the first time. Although the team provided supervision and support remotely, these activities were
delayed as discussed above. Nevertheless, the World Bank team based in Lao PDR office was instrumental to continue
providing timely support to the PMU with remote support from the broader team.
50. Beyond supervision, the project team supported greater coordination with the other World Bank nutrition
convergence projects to achieve the PDO. Specifically, during supervision, the World Bank team actively promoted
the availability of health services for CCT beneficiaries in close coordination with HANSA. More broadly, for nutrition
convergence, the team, with support from CMU, conducted a regular meeting among different nutrition convergence
projects to align efforts toward the same goal of addressing child malnutrition. By coordinating with other projects,
the project helped to integrate nutrition convergence indicators into the other projects. An example is the CLEAR
project, which includes indicators on the use of the Child Scorecard.
Justification of Overall Rating of Bank Performance
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51. Considering the World Bank’s sustained efforts in supporting project implementation and making relevant and timely
interventions to achieve high levels of efficacy, the World Bank’s performance is rated as Satisfactory. The World
Bank supported the government, at the central and local levels, to overcome the delay in the first years of
implementation due to COVID-19; enabled vendors and service provider firms to build a new MIS and payment
systems by advising the PMU on time and in an effective manner; promoted coordination across convergence
projects and implemented a sound M&E system to measure project outcome and inform implementation.
D. RISK TO DEVELOPMENT OUTCOME
52. Financial and government ownership risks. Given the IT linkages between the social registry and the PEDIS, it is
expected that the latter can support management of other social protection interventions nationwide. However, a
prerequisite to continue using the social registry for coordination, planning, and identification of beneficiaries
effectively is the timely update of household information in the system. Information updating is regularly done for
households in the project target districts, but updating of information is a challenge in non-target areas. Updating
the poverty status of households is done once a year, creating a burden because of the large volume of information
that should be processed at the district level every year. Currently, the PEDIS supports the CCT program and data
from the convergence approach. In the future, PEDIS needs to be linked and be able to share information with other
registries, support cross-verification with the other government databases such as the Civil Registration and Vital
Statistics (CRVS) in the Ministry of Home Affairs, and build faster connections with payment delivery providers. The
risks identified may limit the benefits of the information systems. These financial risks will be mitigated by the RRPM
II and investments from other development partners (e.g., Asian Development Bank) which also support the
development, management, update and use information systems as foundational tools for implementing social
protection programs efficiently.
53. Sustainability. Sustainability for this project can be assessed across three dimensions: institutional/operational,
human development, and fiscal. The project has established key social protection building blocks (i.e., Social
Registry, MIS, payment system, targeting system and M&E) to support poor and vulnerable households. These
investments are expected to be sustained and enhanced in the short- and medium-term as the government use
them to scale up the interventions and support the poor, and to respond to disasters in a more effective and
efficient manner. The significant impact on stunting mitigation will be sustained among beneficiaries whose lives
are already on a better trajectory with higher chances of better educational outcomes, jobs, and earnings. While
evidence of the CCT and the convergence approach provides a basis for the government to scale it up, the fiscal
context presents a risk for these investments to be sustained over time. In the near term, the World Bank and other
development partners will have to continue to support these systems to combat malnutrition and poverty in Lao
PDR. Despite these efforts, the sustainability of the activities introduced remains low because of the government’s
relatively weak fiscal outlook. Given the current fiscal situation, in the short term, it is unlikely that the Government
will significantly allocate budgetary resources for the expansion of the interventions.
V. LESSONS AND RECOMMENDATIONS
54. The government commitment, and World Bank support, to implement a multi-sectoral approach to accelerate
stunting reduction has showed promising early results. Against the backdrop of the COVID-19 disruptions and rising
inflation, the convergence of interventions has showed an important impact in terms of mitigating worsening of
malnutrition outcomes. Lessons learned from this project, collected through the monitoring tools and the rigorous
impact evaluation, have informed the design of the second phase of nutrition convergence.28 Notably, convergence
28All four projects, RRPM II, HANSA II, CLEAR, and WASH project, have used findings and data generated from RRPM to enhance their follow-up
operations.
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projects have improved coordination to expand to new target areas, enhancements to the delivery platform and
village coordination through local committees and secretaries.
55. Coordination for convergence, appropriate local funding, and human resource capacity are critical determinants
of success. The overarching national nutrition policy advocates for the involvement of national and subnational
levels, and the engagement of multiple sectors, to combat malnutrition. The Nutrition Convergence has led to several
accomplishments (i.e., regular coordination meetings at national, province and district level, nutrition convergence
coordination guidelines, implementation of monitoring tools). There are emerging lessons learned in the
operationalization of the nutrition convergence program: (i) data-driven and action-oriented coordination meetings
are important to ensure its effectiveness in improving program implementation; (ii) adequate resources and capacity
of provincial and district coordination team are critical to optimally perform its oversight, monitoring and
troubleshooting functions to resolving critical bottlenecks; (iii) clarity on the complementarity between different
coordination mechanisms (District Convergence Committee vs District Nutrition Committee) to ensure synergy; and
(iv) community engagement is essential to facilitate collaboration across different community-level workers and
coordination of services delivery to reach the most vulnerable households.
Recommendations
56. Consider cash transfers indexation to prevent erosion of benefit purchasing power by inflation. Since project
appraisal in 2019, the CCT program increased the amount of benefit twice, just before program launch in 2021 and
late in 2022, but its real value remains lower than what it was in 2021 at the time of its launch: between 2021 and
2023, the nominal value increased by 11 percent, but the real value decreased by 47 percent. The decision to increase
the benefit value was ad hoc and based on the availability of funds. Given the country’s vulnerability to shocks,
including inflation, policy makers can consider establishing a protocol to systematically adjust the benefit, as
appropriate. Furthermore, the balance between maintaining purchasing power and fiscal sustainability should also
be carefully pondered, along with considerations for the “cost of inaction” (the plausible economic gains or forgone
economic multipliers due to non-adjustment of the real benefit value).29
57. Consider expanding the interoperability of the social registry and CCT beneficiary registry with the CRVS.
Connecting social protection management information systems (social registry and beneficiary registry) with the
CRVS, and other administrative databases, can play a crucial role in ensuring the well-being and inclusiveness of
individuals across various socio-economic spectrums, while promoting the efficiency of the social registry operations
for sustainability. Effective and seamless data exchange between these systems is pivotal for enhancing service
delivery, policy formulation, and monitoring of social protection programs. For instance, if social protection MIS are
interoperable with CRVS, programs can have real time access to new birth registration, and in turn, provide timely
access to health and nutrition services, and social protection benefits. Furthermore, interoperability with other
databases can support improved data quality, reduction in the amount of information requested from individuals,
and early verification of program eligibility and faster enrollment processes.
58. Consider increasing the engagement of National Nutrition Committee (NNC) Secretariat in the nutrition
convergence program coordination. Although MPI is neutral agency and has convening power for coordinating
multisectoral program, it would need technical support to effectively lead the coordination and discussion at
substance level. The Department of International Cooperation (DIC) at MPI has mostly conducted program-based
coordination, not a policy or sector wide coordination. Furthermore, MPI-DIC has limited capacity and resources -
limited number of staff dedicated for convergence program – while the NNC Secretariat is better equipped with staff
and resources as well as nutrition knowledge to facilitate the technical and policy discussions.
29“Gentilini, Ugo; Iyengar, Hrishikesh TMM; Valleriani, Giorgia; Aziz, Sheraz; Arimbi, Hana Rakhma; Miranda Nogueira, Jusaine L is; Trujillo, María
Angélica; Cheng, Calvin. 2024. Keep the Pace: How Inflation Erodes Cash Transfers and What to Do About it.
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59. Consider engaging the Planning Department of MPI to support the integration of the nutrition convergence
program into local government planning and budgeting. In addition to the work being done with the DIC and the
Development Research Institute (DRI) in MPI, for coordination and M&E respectively, the Planning Department of
MPI could be more engaged in the nutrition convergence program. This department, as part of their mandate,
supports the regular planning and budgeting process at the provincial and district levels. This will help with the
prioritization of nutrition services in the local government plan and budget, which in turn helps institutionalizing the
convergence program for sustainability. The Planning Department will also play a significant role in the development
of nutrition resources tracking, in collaboration with Ministry of Finance, to better understand the resources going
to nutrition and evaluate the spending efficiency of the limited resources.
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ANNEX 1. RESULTS FRAMEWORK AND KEY OUTPUTS
@#&OPS~Doctype~OPS^dynamics@icrresultframework#doctemplate
A. RESULTS FRAMEWORK
PDO Indicators by Outcomes
Objective 1: Develop a targeting, information, and monitoring system for social protection programs
Indicator Name Baseline Closing Period (Original) Closing Period (Current) Actual Achieved at Completion
Result Month/Year Result Month/Year Result Month/Year Result Month/Year
0.00 Sep/2018 80.00 Dec/2023 100.00 Feb/2024
Indicator 1: Percentage of
Comments on achieving targets Numerator: Number of households in the target area for whom the socio-economic PMT questionnaire has
households with periodically updated
been administered at the household level and data migrated to the social registry. The PMT will be applied
socio-economic survey information
every two years and information will be available in the social registry no later than 2 months after
reported in the social registry.
implementation of the survey. Denominator: Total number of estimated households living in the target area.
(Percentage)
The estimated number of overall households living in the target area would come from population estimates.
Objective 2: Improve nutrition behaviors
Indicator Name Baseline Closing Period (Original) Closing Period (Current) Actual Achieved at Completion
Result Month/Year Result Month/Year Result Month/Year Result Month/Year
Beneficiaries of social safety net 0.00 Nov/2018 42,743.00 Dec/2023 43,597.00 Dec/2023
programs (Number)
Beneficiaries of social safety 0.00 38,460.00 39,302.00
net programs - Female
(Number)
Indicator 3: Percentage of children 6– 0.00 Sep/2018 40.00 Dec/2023 36.10 Jun/2023
23 months from cash transfer Comments on achieving targets Numerator: Children, 6-23 months old from cash transfer beneficary housholds who are reported to have
beneficiary households consuming consumed at least four out of the seven reccomended food groups (using a classification of food groups based
foods from four or more on international recommendations) during the 24 hours preceding the time of interview. Denominator: Total
recommended food groups. number of children 6-23 months from cash transfer beneficary housholds in the area of intervention.
(Percentage)
Objective 3: Enhance convergence of the multisectoral nutrition approach in targeted provinces
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Indicator Name Baseline Closing Period (Original) Closing Period (Current) Actual Achieved at Completion
Result Month/Year Result Month/Year Result Month/Year Result Month/Year
Indicator 4: Number of villages in 0.00 Oct/2018 528.00 Dec/2023 544.00 Dec/2023
project districts where at least three Comments on achieving targets Number of villages in the target districts in which three or more projects (from health, WASH,
nutrition convergence projects have PRF, IFAD financed project, and this project) are implementing their respective project
been implemented. (Number) activities. IFAD and PRF will be implemented in separate villages.
Intermediate Indicators by Components
Component 1: Developing the building blocks of a social protection system
Indicator Name Baseline Closing Period (Original) Closing Period (Current) Actual Achieved at Completion
Result Month/Year Result Month/Year Result Month/Year Result Month/Year
No Sep/2018 Yes Dec/2023 Yes Dec/2023
Comments on achieving targets This indicator is met if the social and beneficiary registry information systems are developed and operational
Indicator 1: Development of a social where developed means that the information systems software are developed and operational means that they
registry. (Yes/No) are working on line. The information collected as part of the socio-economic survey will be regularly migrated
into the social registry, and for the beneficiary registry in the aea of interventions information on CCT program
beneficiaries and on beneficiaries of WB financed nutrition convergence programs will be reported.
0.00 Sep/2018 90.00 Dec/2023 100.00 Dec/2023
Indicator 2: Percentage of
households surveyed with the PMT Comments on achieving targets Numerator: Number of households surveyed with the PMT questionnaire in the target areas Denominator:
questionnaire in target areas. Number of households living in the target area. The estimated number of overall households living in the target
(Percentage) areas would come from population estimates and from the household level survey collected for the overall
nutrition convergence approach impact evaluation every other year.
Component 2: Conditional cash transfer program
Indicator Name Baseline Closing Period (Original) Closing Period (Current) Actual Achieved at Completion
Result Month/Year Result Month/Year Result Month/Year Result Month/Year
Indicator 3: Percentage of project 0.00 Sep/2018 90.00 Dec/2023 92.24 Dec/2023
beneficiary households who Comments on achieving targets This information is from the CCT MIS. Since the MIS data cannot differentiate those who
participate in community nutrition
sessions at least once per month. actually received the services and those who could not receive the services due to a lack of
(Percentage) services, the record reported here could be higher than the actual rate.
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0.00 Sep/2018 80.00 Dec/2023 35.55 Dec/2023
Indicator 4: Percentage of cash Comments on achieving targets This indicator is meant to capture the efficacy of project delivery systems, specifically payment systems. A
transfers reaching target areas within schedule for cash transfer payments will be developed once all systems are in place, taking into consideration
5 days of scheduled payment date. the time it takes for each step to be completed, to the point where the cash is made available for collection by
(Percentage) its intended beneficiary. This indicator will only measure the timeliness of the cash transfer in terms of when it
is made available to the beneficiaries (in cash or as electronic payment). Cash collection by beneficiaries will not
be measured by this indicator.
Indicator 5: Percentage of children 0.00 Sep/2018 40.00 Dec/2023 97.08 Dec/2023
under 2 years from cash transfer Comments on achieving targets This information is from the CCT MIS. Since the MIS data cannot differentiate those who
beneficary housholds receiving
growth monitoring and promotion actually received the services and those who could not receive the services due to a lack of
services according to the standard services, the record reported here could be higher than the actual rate.
monitoring schedule. (Percentage)
Indicator 6: Number of female village 0.00 Jul/2018 1,600.00 Dec/2023 1,846.00 Dec/2023
facilitators trained to use new SBCC Comments on achieving targets The new SBCC tools are being developed.
tools. (Number)
0.00 Jul/2018 90.00 Dec/2023 100.00 Dec/2023
Indicator 7: Percentage of grievances Comments on achieving targets As discussed in the GRM section, the stipulated service standards for response times are
addressed and/or resolved within the
stipulated service standards for
currently being reviewed and updated in the Cash Transfer Manual, and thus the actual data
response times. (Percentage) could not be captured in the current reporting period. It is expected to be repoted from the
next reporting period.
Indicator 8: Percentage of female 0.00 Oct/2018 90.00 Dec/2023 97.50 Dec/2023
direct cash transfer recipients who Comments on achieving targets This indicator refers to the CCT beneficiaries and will only be reported after the impact
report increased decision-making
power on spending decisions for the evaluation mid-line will be collected in summer 2022.
household. (Percentage)
Indicator 9: Percentage of pregnant 0.00 Jul/2018 60.00 Dec/2023 94.72 Dec/2023
women from cash transfer beneficary Comments on achieving targets
This information is from the CCT MIS. Since the MIS data cannot differentiate those who
housholds with at least 4 ANC
contacts during their pregnancy. actually received the services and those who could not receive the services due to a lack of
(Percentage) services, the record reported here could be higher than the actual rate.
Component 3: Coordination, management, monitoring and evaluation
Indicator Name Baseline Closing Period (Original) Closing Period (Current) Actual Achieved at Completion
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Result Month/Year Result Month/Year Result Month/Year Result Month/Year
0.00 Sep/2018 3.00 Dec/2023 1.00 Dec/2023
Indicator 10: Number of spot checks
Comments on achieving targets Although COVID-19 delayed the implementation of a systematic spot check, the first spot
implemented. (Number)
check was implemented.
Indicator 11: Percentage of project 0.00 Sep/2018 90.00 Dec/2023 100.00 Dec/2023
districts convening a multisectoral
nutrition coordination meeting at
least once every three (3) months.
(Percentage)
0.00 Jul/2018 90.00 Dec/2023 100.00 Dec/2023
Indicator 12: Percentage of cash Comments on achieving targets The PMU prepares the report monthly using the CCT MIS. However, it is currently relying on
transfer monthly reports generated
in a timely manner. (Percentage) the manual process of exporting and creating a report. The PMU is in the process of
automating the reporting functions of the MIS.
Indicator 13: Number of cross- 0.00 Nov/2018 3.00 Dec/2023 2.00 Dec/2023
sectoral surveys carried out to Comments on achieving targets The objective of this indicator is to report on the evaluation of the overall nutrition convergence approach. The
evaluate different convergence number of cross-sectoral surveys refers to independent surveys carried out for the purpose of evaluating the
interventions. (Number) impact of the convergence approach.
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Objective 1: Develop a targeting, information, and monitoring system for social protection programs
1. Percentage of households with periodically updated socio-economic
survey information reported in the social registry.
PDO Indicators 2. Beneficiaries of social safety net programs
3. Percentage of children 6–23 months from cash transfer beneficiary
households consuming foods from four or more recommended food groups.
Objective 2: Improve nutrition behaviors
3. Beneficiaries of social safety net programs
5. Indicator 3: Percentage of children 6–23 months from cash transfer
PDO Indicators
beneficiary households consuming foods from four or more recommended
food groups.
Objective 3: Enhance convergence of the multisectoral nutrition approach in targeted provinces
4: Number of villages in project districts where at least three nutrition
PDO Indicators
convergence projects have been implemented.
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Component 3: Coordination, management, monitoring and evaluation
10: Number of spot checks implemented.
11: Percentage of project districts convening a multisectoral nutrition
coordination meeting at least once every three (3) months.
Intermediate Results Indicators 12: Percentage of cash transfer monthly reports generated in a timely
manner.
13: Number of cross-sectoral surveys carried out to evaluate different
convergence interventions.
Component 2: Conditional cash transfer program
3: Percentage of project beneficiary households who participate in community
nutrition sessions at least once per month.
4: Percentage of cash transfers reaching target areas within 5 days of
scheduled payment date.
5: Percentage of children under 2 years from cash transfer beneficary
housholds receiving growth monitoring and promotion services according to
the standard monitoring schedule.
Intermediate Results Indicators
6: Number of female village facilitators trained to use new SBCC tools.
7: Percentage of grievances addressed and/or resolved within the stipulated
service standards for response times.
8: Percentage of female direct cash transfer recipients who report increased
decision-making power on spending decisions for the household.
9: Percentage of pregnant women from cash transfer beneficary housholds
with at least 4 ANC contacts during their pregnancy.
Component 1: Developing the building blocks of a social protection system
2. Indicator 1: Development of a social registry.
Intermediate Results Indicators 3. Indicator 2: Percentage of households surveyed with the PMT
questionnaire in target areas.
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ANNEX 2. BANK LENDING AND IMPLEMENTATION SUPPORT/SUPERVISION
A. TASK TEAM MEMBERS
Name Role
Kenichi Victor Nishikawa Chavez Team Leader
Ali Winoto Subandoro Team Leader
Yasuhiro Kawasoe Team Leader
Siriphone Vanitsaveth Financial Management Specialist
Sirirat Sirijaratwong Procurement Specialist
Viengkeo Phetnavongxay Environmental Specialist
Martin Fodor Environmental Specialist
Upulee Iresha Dasanayake Social Specialist
Sybounheuang Phandanouvong Social Specialist
Mei Wang Counsel
Thongdeuane Nanthanavone Procurement Team
Silima Keopaseuth Procurement Team
Kalesh Kumar Anandavalliamma Karunakarakurup Procurement Team
Alina Phonvisay Procurement Team
Tanida Arayavechkit Team Member
Manuel Salazar Team Member
Boualamphanh Phouthavisouk Team Member
Anorath Douangphachanh Team Member
Lattana Thoommaly Team Member
Ashish Joshi Team Member
Yashodhan Ghorpade Team Member
Luisa Patricia Fernandez Delgado Team Member
Thao Do Team Member
Chindavanh Vongsaly Team Member
Jorge Eduardo Avalos Team Member
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@#&OPS~Doctype~OPS^dynamics@icrannexstafftime#doctemplate
B. STAFF TIME & COST
Staff Time & Cost
Stage of Project Cycle
No. of Staff Weeks US$ (including travel and consultant costs)
Preparation
FY17 32.305 159,352.44
FY18 36.428 182,134.83
FY19 34.718 233,099.83
FY20 0.000 16,405.55
Total 103.45 590,992.65
Supervision/ICR
FY19 2.025 48,483.08
FY20 43.602 303,565.95
FY21 67.958 351,269.55
FY22 29.211 286,753.82
FY23 37.304 303,343.59
FY24 37.114 273,808.64
FY25 13.393 67,713.06
Total 230.61 1,634,937.69
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ANNEX 3. PROJECT COST BY COMPONENT
Component Amount at Approval (US$M) Actual at Project Closing (US$M)
Component 1: Developing the
building blocks of a social protection 3.0 3.00
system
Component 2: Conditional cash
13.6 13.57
transfer program
Component 3: Coordination,
management, monitoring and 7.3 7.30
evaluation
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ANNEX 4. EFFICIENCY ANALYSIS
The project investments generated substantial efficiencies, though not all can be quantified. While it will take time to realize
the full potential benefits of the project investments, the modernization of the administration of the Decree 348 Poverty
data, the development of the CCT , and convergence coordination resulted in efficiency gains across several dimensions,
including: (i) establishment of a social registry to modernize Decree 348 Poverty data administration and management
improved efficiency for administrators and beneficiaries; (ii) although the cost-effectiveness of the CCT program was
modest given the large initial costs, the program became a key contributor to addressing stunting and supported poor
households during periods of high inflation; and (iii) the co-location and coordination of project activities contributed
significantly to better nutrition outcomes.
The cost efficiencies generated by the Social Registry outweighs the costs of developing and operating the system over
time. The project has significantly improved the efficiency of managing Decree 348 Poverty data in Lao PDR through its
support of the Social Registry (information system and database) and the introduction of the PMT method. Before the
project, the management of the Poverty data was manual and paper based and encoded in spreadsheets, which resulted
in a highly inefficient and non-transparent system. Provincial- and district-level staff were only able to aggregate household
level data but could not track, manage, or report on the socio-economic data of households and individuals given that the
information was not digitalized, centralized, and easily accessible. The Social Registry was designed to capture household
and individual level information to generate efficiencies and savings on administration costs and allow for ranking of
households based on a proxy-welfare indicator (through the PMT method). Some of these cost efficiencies include reducing
paper and storage costs across all districts in the country; identifying objectively potential beneficiaries for social protection
and disaster response programs;30 preventing, detecting, and remedying data collection errors; and reducing processing
time and cost for monitoring and reporting. It is expected that overall and over time resource savings are substantially
higher than the US$3 million invested in hardware, designing, and developing the system, and providing training to operate
it.
The cost of developing the Social Registry is reasonable in relation to the volume of beneficiaries it can serve and is
comparable internationally. The estimated cost at US$1.6 per household31 is minor relative to the savings generated by
improved administration of data.32 As a comparison, Türkiye’s Integrated system cost US$1.3 per household, excluding
training cost. The project investments on the Social Registry and the PMT method enable administrators to have timely
access to socio-economic indicators for operational management and policy making, as it also supports planning, assessing
of potential demand, monitoring, reporting, and other analytics.
Table 1: Cost breakdown for the Social Registry
Item Amount (US$)
Design and development of database and MIS 766,000
Computers and other hardware 632,340
Training and technical support33 1,380,000
30 Potential beneficiaries may have been left out without the development of the Social Registry.
31 Estimate based on the costs to establish the social registry and conduct data collection (except training), and the 1.2 million households
enumerated.
32 Estimating cost efficiency of the SR presents a challenge given that estimating and comparing registries is not straightforward. Registries incur
different types of administrative costs, and the costs are spread out over time.
33 Technical support includes hiring of IT officers at central and provincial level during project implementation.
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Item Amount (US$)
Data collection (per diem and logistics)34 675,100
Total 3,453,440
Note: Total cost does not include development of the PMT method.
The cost-effectiveness of the CCT program was modest given the large initial investments in setting up its targeting and
service delivery mechanisms. An analysis of the costs and benefits of the CCT suggests that the program was a ‘moderate’
cost-effective option for reducing (or mitigating) stunting and other maternal and child indicators. Cost-effectiveness
analysis (CEA) calculates the ratio of the amount of “effect” a program achieves for a given amount of cost incurred, or
conversely the amount of cost required to achieve a given impact.35 The cost-effectiveness analysis estimated shows that
the CCT program led to a 0.03 percentage point reduction in stunting per US$100 spent (or a cost of US$4,430 per case of
child stunting averted). The cost-effectiveness of CCTs was modest given the large initial costs of establishing the building
blocks for a national social protection system.36 The CEA estimate for the CCT is probably an underestimation of the cost-
effectiveness of the program given that program’s impact is only measured over two years, but costs are included for goods
that can continue to be used over many more years. The CEA estimate does not exclude costs that may overlap with other
programs in the future (e.g., new programs piggybacking on the Social Registry and targeting method to identify
beneficiaries). Moreover, the CCTs aim to achieve objectives other than reducing malnutrition. CEA estimates for the CCT
over a longer period are more favorable as they suggest greater cost-effectiveness due to the lower administrative cost of
implementing the program and an expected higher significant impact on stunting.37 Furthermore, ratios of cash transfer to
administrative cost will improve as the CCT program expands geographically to other areas.38
ANNEX 5. BORROWER, CO-FINANCIER AND OTHER PARTNER/STAKEHOLDER COMMENTS
Comments sent by email from Mme. Bakeo Souvannalath, Deputy Director General, Department of Rural Development
(DRD) on February 12, 2025.
Dear Mr. Kenichi Nishikawa,
Thank you for your email. We have reviewed the World Bank’s Implementation Completion and Results Report. We
found it consistent with MAFs own Implementation Completion Report and hence agree with the assessment presented
in it.
Best regards,
Bakeo Souvannalath on behalf of the RRPM project team
34 Data collection expenses for two rounds of data collection.
35 CEAs are unable to capture all benefits of a particular program. Instead, they compare interventions on a single common outcome. Dhaliwal et al
2012 provides a standardized approach to applying cost-effectiveness analysis.
36 The social registry investment was a countrywide investment. While the CCT was implemented only in twelve districts of four provinces, most of
the processes and systems develop can support nationwide scale up.
37 Excluding convergence and M&E activities, transfer cost represents nearly half of project financing (47 percent), followed by administrative cost
(35 percent) and targeting (17 percent).
38 The Asian Development Bank is preparing a project which will expand the CCT program to other provinces in Lao PDR.
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