The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) Benin Health System Enhancement Program (P172940) (P172940) WESTERN AND CENTRAL AFRICA | Benin | Health, Nutrition & Population Global Practice | Requesting Unit: AWCF2 (6551) | Responsible Unit: HAWH2 (9542) IBRD/IDA | Program-for-Results Financing | FY 2022 | Team Leader(s): Netsanet Walelign Workie, Fatoumata Binta Maama Barry Seq No: 5 | Archived on 01-Aug-2024 | ISR01318 | Created by: Fatoumata Binta Maama Barry on 17-Jul-2024 | Modified by: Fatoumata Binta Maama Barry on 26-Jul-2024 1. PROJECT DEVELOPMENT OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 27-Apr-2022) To improve the quality of and access to primary health care services with a focus on reproductive, maternal, neonatal, child, adolescent health and nutrition (RMNCAH+N) and strengthen public health emergency preparedness and response capacity 2. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Moderately Unsatisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Moderate 3. KEY ISSUES & STATUS 3.1 Implementation Status and Key Decisions 4. DATA ON FINANCIAL PERFORMANCE Apr 13, 2025 Page 1 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) 4.1 Disbursements (by loan) Loan/Credit/TF Status Original Revised Cancelled Disbursed Undisbursed % Disbursed IDA-E0020 Effective 93.50 85.65 0.00 21.64 63.85 25.31% IDA-70800 Effective 93.50 89.42 0.00 39.43 48.05 45.07% 4.2 Key Dates (by loan) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing IDA-70800 Effective 27-Apr-2022 10-May-2022 27-Jul-2022 30-Jun-2027 30-Jun-2027 IDA-E0020 Effective 27-Apr-2022 10-May-2022 27-Jul-2022 30-Jun-2027 30-Jun-2027 4.3 Program Action Plan Action Description Recruitment by the Ministry of Health of the firm and working group in support of works. Source DLI# Responsibility Timing Timing Value Status Project Technical NA Coordination Unit Due Date 30-Nov-2022 Completed (PCU) Recruitment of: Completion - The firm in charge of the detailed design and supervision of the construction, rehabilitation, Measurement and extension works of the health infrastructures supported by the programme - The working group for the preparation of tender documents Comments The AISEM has an operational manual for the preparation of tender documents. Action Description Development of the Procedure Manual Source DLI# Responsibility Timing Timing Value Status Ministry of Health Technical NA Due Date 31-Dec-2022 Completed (MOH), ANSSO Completion The Program's Procedure Manual is developed by the ANSSP. The World Bank approves the Measurement Procedure Manual. 120 days after entry into force of the programme. Comments The manual was completed and approved as an effectiveness condition Apr 13, 2025 Page 2 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) Action Description Strengthening the Program Environmental and Social Management system. Source DLI# Responsibility Timing Timing Value Status UCP, Beninese Environmental and NA Environment Due Date 15-Feb-2024 Completed Social Systems Agency (ABE) Development of a Civic Engagement Plan and implementation of the civic engagement Completion mechanism. No later than six (6) months after the date of entry into force of the program Measurement and its implementation throughout the life cycle of the program. The consultant to develop the Stakeholder Engagement Plan (SEP) has been hired. The SEP Comments has been validated internally with the Client and at the Bank. Action Description Strengthening the Program Environmental and Social Management system. Source DLI# Responsibility Timing Timing Value Status PCU, Beninese Environmental and NA Environmental Due Date 29-Jun-2025 Delayed Social Systems Agency (ABE) Completion An agreement between ANSSP and Beninese Environmental Agency (ABE) will be concluded Measurement by June 30, 2025. The draft agreement is available. The Bank team recommends accelerating the process of establishing an ANSSP/ABE Comments agreement so that ABE can assist with these capacity-building activities. Action Description Strengthening the Program's Environmental and Social Management System. Source DLI# Responsibility Timing Timing Value Status Environmental and UCP, MS (CEGCC), NA Due Date 30-Jun-2024 Delayed Social Systems ABE, ANDF Development and implementation of the Technical Manual for Environmental and Social Completion Management of the Program. Preparation no later than three (3) months after the date of Measurement entry intro force of the program and implementation throughout the life cycle The contract of the consultant to draft the technical manual for E&S management of the Program is signed. The feedback workshop on the draft Comments E&S manual took place on September 9, 2024. The consultant is incorporating comments from the WB team review Apr 13, 2025 Page 3 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) Action Description Strengthening the technical and institutional capacities of actors and stakeholders Source DLI# Responsibility Timing Timing Value Status UCP, MS, ABE, Environmental and NA ANDF, DDS, Recurrent Continuous In Progress Social Systems DDCVDD Organization of training sessions directly targeting the parties involved in the Completion implementation of the project. Start of sessions in the first half of the year after the date of Measurement entry into force of the program. Refresher sessions throughout the life The Stakeholder Engagement Plan has been finalized. Following the restitution workshop for the draft E&S manual held on September 9, Comments 2024, the Bank suggests that ANSSP begins drafting the ToR for these training sessions. Action Description Capacity building (technical and institutional) of actors and stakeholders Source DLI# Responsibility Timing Timing Value Status Environmental and NA UCP, MS (CEGCC) Due Date 30-Aug-2022 In Progress Social Systems Appointment/recruitment of four environmental specialists (2) and social specialists (2), for Completion the PCU and within MOH (CEGCC) and within the MOH (Gender Environment Unit (1) and Measurement Climate Change (1) (CEGCC) at the start of implementation. Two specialists have been appointed: (i) an environmental specialist on Climate Change and Comments (ii) a social specialist from the Gender and Environment Unit of the Ministry of Health to support the ANSSP. Action Description Capacity building (technical and institutional) of actors and stakeholders Source DLI# Responsibility Timing Timing Value Status Environmental and UCP, MC (CEGCC), NA Recurrent Continuous In Progress Social Systems ABE Information and awareness activities on environmental and social management will be Completion implemented in the first year and continue throughout the Program. This includes Measurement information sessions, workshops, and media, with communication specialists involved. The WB fiduciary team conducted capacity-building sessions in July 2024, with another Comments session planned for December 2024. Action Description Strengthening the Program Environmental and Social Management System. Apr 13, 2025 Page 4 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) Source DLI# Responsibility Timing Timing Value Status Environmental and UCP, MS (CEGCC), NA Due Date 30-May-2024 Completed Social Systems DPHAB Development and implementation of a guide for the development of waste management Completion plans (biomedical waste). No later than 90 days after the date of entry into force of the Measurement program. (Biomedical and other waste). NB: waste produced in health facilities The biomedical waste plan has been validated. There has been an exchange and document Comments sharing with REDISSE. The nominated environmental specialist will take the lead in the implementation of the biomedical waste plan. Action Description Strengthening the Program's Environmental and Social Management system. Source DLI# Responsibility Timing Timing Value Status Environmental and PCU, MOH (CEGCC), NA Due Date 29-May-2024 In Progress Social Systems DPHAB Development and implementation of the grievance mechanism (GRM). No later than six (6 Completion months) after the date of entry into force of the program and its implementation Measurement throughout the life cycle of the program. The GRM document has been prepared and validated by the Bank. The implementation of Comments the GRM is ongoing and the consultant is integrating the inputs from the WB and the MoH. Action Description Report on and investigate fraud and corruption Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NA MOH Recurrent Semi-Annually Completed Two internal audit missions will be conducted: Semester 1 by internal auditors of Completion implementing structures, with reports compiled by ANSSP's internal auditor. Semester 2 by Measurement IGM, based on reports from all implementing structures. Comments There is no suspected cases of corruption and fraud since the start of the Program. Implement the 2020 Public Procurement Code so SOBAPS operates with appropriate Action Description procurement regulations. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NA MS/SOBAPS Due Date 30-Sep-2022 Completed Completion - SOBAPS procurement regulations are enacted by decree (see CCJ) Measurement Apr 13, 2025 Page 5 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) Comments This has been completed. Action Description Procurement of works Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NA Ministry of Health Recurrent Continuous Completed Completion Update the standard plans for the construction of health infrastructure (see DG AISEM) Measurement Comments This has been completed. Action Description Management of works contracts Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NA Ministry of Health Due Date 30-Nov-2022 Completed Works contract management manual. Establishment of a contract performance management Completion plan, definition of roles and responsibilities of stakeholders. A first manual is needed and Measurement thereafter it must be continuously updated. Comments This has been completed. Action Description Budget planning Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NA Ministry of Health Recurrent Yearly Completed Transmission of the draft budget N + 1 budget and the DPPD N + 1 DPPD (Multi Annual Completion expenditure Programming Document) to IDA for technical opinion before 30/09/N (share Measurement with the Bank the draft budget each year, at the latest on 30 September. Comments This action has been completed during this budget cycle (CY24). Action Description Cash Management Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NA MOH/MEF Recurrent Quarterly In Progress Transmission of the quarterly statement of payment arrears on the 60 days program at the Completion end of each quarter. (DPAF/DAF will have to issue the instances of payment of benefits. Measurement Clarify the situation with the Treasury. Comments This has not been completed as of yet. No payment in arrears. Apr 13, 2025 Page 6 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) Action Description Conduct Internal Audits Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NA MoH/ MEF Recurrent Semi-Annually In Progress Conduct two internal audit missions of the Program per year by the IGF and the IGM with Completion transmission of reports to IDA 60 days after the end of the semester. Compilation of the Measurement reports of the different missions in one semester: IGM/IGF. The team noted that ANSSP has its own internal audit unit consisting of two auditors, under Comments the supervision of the IGF/IGM. The internal audit of the Program has yet to be submitted. Action Description Transmission of external audit reports Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NA MOH Recurrent Yearly In Progress Completion Transmission of the external audit report nine (9) months after the end of each budgetary Measurement year (i.e. 30 September). Audit reports are due since 30 September 2024. The recruitment of the external audit is still Comments in progress with the Court of Accounts. Action Description Recruitment of independent external auditor Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NA MOH/SAI Due Date 28-Jan-2022 Delayed Completion Recruitment of an independent external auditor within six (6) months of entry into force to Measurement conduct an annual audit of the Program. (Legal Commitment) Comments The external auditor will be recruited by the Court of Accounts. 5. KEY DATES Key Events Planned Actual Approval 27-Apr-2022 27-Apr-2022 Effectiveness 27-Jul-2022 27-Jul-2022 Mid-Term Review No. 01 29-Nov-2024 Operation Closing/Cancellation 30-Jun-2027 Apr 13, 2025 Page 7 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) 6. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Last Approved Rating Risk Category Approval Package - ISR Seq. 04 - 14 Feb Proposed Rating 27 Apr 2022 2024 Political and Governance Moderate Moderate Moderate Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Substantial Moderate Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and Substantial Moderate Moderate Sustainability Fiduciary Substantial Moderate Substantial Environment and Social Substantial Moderate Moderate Stakeholders Moderate Moderate Moderate Overall Substantial Moderate Moderate Apr 13, 2025 Page 8 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) 7. RESULTS 7.1 PDO Indicators by PDO Outcomes Quality Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 6.20 Jun/2020 0.00 05-Feb-2024 6.88 06-May- 9.70 Jun/2025 Long-Acting Contraceptive 2024 users (DLI 2) Comments on Waiting on ISRP validation report (Percentage) DLI achieving targets Full immunization coverage 57.00 Jun/2019 0.00 05-Feb-2024 49.56 06-May- 65.00 Jun/2024 for children between the 2024 ages of 12 to 23 months Comments on Waiting on ISRP validation report (DLI 3) (Percentage) DLI achieving targets Health Facilities with no 70.00 Jun/2021 0.00 05-Feb-2024 0.00 06-May- 80.00 Jun/2025 stock-out of Maternal and 2024 Child Health Tracer Drugs in Comments on Waiting on ISRP validation report the past three (3) months achieving targets (DLI 4) (Number) DLI Access Baseline Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Month/Year Pregnant women of reproductive age accessing health 50.00 Jun/2021 0.00 06-May- 70.00 Jun/2026 facilities for reproductive health consultation 2024 (Percentage) Emergency Preparedness and Response Apr 13, 2025 Page 9 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Operationalization of the No Jun/2022 No 05-Feb-2024 Yes 06-May- Yes Jun/2025 health sector quality 2024 assurance system (DLI 8) Comments on Waiting on ISRP validation report for DLR 8.2 and 8.3. DLR 8.4 has not commenced. (Yes/No) DLI achieving targets 7.2 Intermediate Results Indicators by Results Areas Access and Quality Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Percentage of newborns 41.00 Jun/2021 0.00 06-May-2024 60.00 Jun/2026 attended by skilled provider within 48 hours of birth (Percentage) Number of children under 5 51.00 Jun/2021 0.00 05-Feb-2024 0.00 06-May-2024 65.00 Jun/2026 treated for moderate (MAM) or severe acute malnutrition (SAM) (Percentage) Number of Adolescent and 0.00 Jun/2021 11 06-May-2024 50.00 Jun/2026 Youth Friendly Centers (Number) Children less than 6 months 42.00 Jun/2021 0.00 06-May-2024 55.00 Jun/2026 exclusively breastfed (Percentage) Apr 13, 2025 Page 10 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) Percentage of beneficiaries 0.00 Jun/2021 0.00 05-Feb-2024 0.00 06-May-2024 80.00 Jun/2026 satisfied with access, quality of services, quality of facilities, responsiveness to needs (Percentage) Grievances responded 0.00 Jun/2021 0.00 05-Feb-2024 0.00 06-May-2024 80.00 Jun/2026 and/or resolved within the stipulated service standards for response times (Percentage) Health System Capacity and Emergency Preparedness and Response Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Proportion of Health 0.00 Jun/2021 0.00 05-Feb-2024 0.00 06-May-2024 75.00 Jun/2026 Facilities with the minimum standard of skilled health workers as per the national guidelines (Percentage) Proportion of private health 0.00 Jun/2021 0.00 05-Feb-2024 0.00 06-May-2024 75.00 Jun/2026 facilities whose data are fully integrated into the HMIS (Percentage) Number of Health 119.00 Jun/2021 0.00 05-Feb-2024 57 06-May-2024 371.00 Jun/2026 Professionals who have completed an epidemiology or laboratory training on surveillance, preparedness, and response to public health emergencies (DLI 5) (Number) DLI Apr 13, 2025 Page 11 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) 7.3 Disbursement Linked Indicators (DLI) Actual (Previous) Actual (Current) PBC Name Baseline Closing Period Value Date Value Date 1:Proportion of Value 35.00 0.00 0.00 60.00 Targeted Health Facilities Offering Basic Emergency Obstetric and Allocated 01-Nov-2023 06-May-2024 Newborn Care 0.00 0.00 3,960,000.00 Amount (BEmONC) Services (Percentage) Not Due DLI allocation 19,800,000.00 2:Proportion of Value 0.00 6.88 9.70 Long-Acting Contraceptive Users Allocated 01-Nov-2023 06-May-2024 (Percentage) 0.00 5,040,000.00 Amount Not Due DLI allocation 19,600,000.00 3:Proportion of full Value 0.00 49.56 65.00 immunization coverage for Allocated 01-Nov-2023 06-May-2024 children between 0.00 2,750,000.00 Amount the ages of 12 to 23 Apr 13, 2025 Page 12 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) months (Percentage) Not Due DLI allocation 22,000,000.00 4:Proportion of Value 0.00 0.00 80.00 Health Facilities with no stock-out of Maternal and Child Health Tracer Drugs Allocated 01-Nov-2023 06-May-2024 in the past three (3) 0.00 4,000,000.00 Amount months (Percentage) Not Due DLI allocation 20,000,000.00 5:Number of Health Value 119.00 0.00 57 371.00 Professionals who have completed an epidemiology or laboratory training on surveillance, Allocated 01-Nov-2023 06-May-2024 preparedness, and 0.00 0.00 4,200,000.00 Amount response to public health emergencies (Number) Partially achieved DLI allocation 30,240,000.00 Value 90.50 0.00 01-Nov-2023 99.60 06-May-2024 95.00 Apr 13, 2025 Page 13 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) 6:Proportion of births attended by a Skilled Health Allocated 0.00 0.00 4,000,000.00 Professional Amount (Percentage) Not Due DLI allocation 18,000,000.00 7:Number of Health Value 0.00 0.00 6 25.00 Facilities with new health care buildings constructed and Allocated 01-Nov-2023 06-May-2024 equipped as further 0.00 0.00 3,000,000.00 Amount detailed in the POM (Number) Partially achieved DLI allocation 37,500,000.00 8:Operationalization Value No No Yes of the Health Sector Quality Assurance Allocated 01-Nov-2023 06-May-2024 System (Yes/No) 0.00 4,000,000.00 Amount Partially achieved DLI allocation 20,000,000.00 8.1:DLR 8.1: A Value No No Yes Yes Regulatory Health Sector Allocated 01-Nov-2023 06-May-2024 Authority is 0.00 0.00 0.00 established and Amount operational as Apr 13, 2025 Page 14 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) evidenced by the achievement of specific milestones detailed in the POM on or before December 31, 2022 (Yes/No) Achieved DLI allocation 4,000,000.00 8.2:DLR 8.2: The Value No No Yes Health Sector Quality Assurance Policy has been adopted by the Regulatory Allocated 06-May-2024 Health Sector 0.00 0.00 0.00 Amount Authority on or before December 31, 2024 (Yes/No) Not Due DLI allocation 4,000,000.00 8.3:DLR 8.3: Value 0.00 0.00 70.00 70% of Health Allocated 06-May-2024 Districts that 0.00 0.00 2,200,000.00 Amount Apr 13, 2025 Page 15 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) have began implementing the Health Sector Quality Assurance Policy as evidenced by the achievement of key milestones further detailed in the POM (Percentage) Not Due DLI allocation 8,000,000.00 8.4:DLR 8.4: The Value No No Yes Ministry of Health has approved an accreditation process for health personnel and Allocated 06-May-2024 certification 0.00 0.00 0.00 Amount process for Health Facilities on or before December 31, 2026 (Yes/No) Not Due Apr 13, 2025 Page 16 of 17 The World Bank Implementation Status & Results Report Benin Health System Enhancement Program (P172940) (P172940) DLI allocation 4,000,000.00 Apr 13, 2025 Page 17 of 17