Report No: RES01299 INTERNATIONAL DEVELOPMENT ASSOCIATION RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF THE IMMUNIZATION PLUS AND MALARIA PROGRESS BY ACCELERATING COVERAGE AND TRANSFORMING SERVICES PROJECT — PHASE 1 UNDER THE MULTI-PHASE PROGRAMMATIC APPROACH WITH AN OVERALL FINANCING ENVELOPE OF US$1.5 BILLION EQUIVALENT APPROVED ON FEBRUARY 18, 2020 TO THE FEDERAL REPUBLIC OF NIGERIA DECEMBER 4, 2025 HEALTH, NUTRITION AND POPULATION GLOBAL PRACTICE WESTERN AND CENTRAL AFRICA REGION Regional Vice President: Ousmane Diagana Regional Practice Director: Trina S. Haque Division Director: Mathew A. Verghis Practice Manager: Rifat Afifa Hasan Task Team Leaders: Onoriode Ezire, Chijioke Samuel Okoro This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. Official Use Only The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) ABBREVIATIONS AND ACRONYMS ACT Artemisinin Combination Therapy BEmONC Basic Emergency Obstetric and Newborn Care CERC Contingent Emergency Recovery Component DFF Decentralized Financing Facility DHIS District Health Information System E&S Environmental and Social ESMP Environmental and Social Management Plan FMoH Federal Ministry of Heath HMIS Health Management Information System HNP Health, Nutrition and Population IMPACT Immunization plus and Malaria Progress by Accelerating Coverage and Transforming services IPF Investment Project Financing IPT Intermittent Presumptive Therapy ISDS Integrated Safeguards Data Sheet ISR Implementation Status and Results Report LLIN Long-lasting Insecticide Treated Net LQAS Lot Quality Assurance Sampling MICS Multiple-Indicator Cluster Survey MPA Multiphase Programmatic Approach NDHS National Demographic and Health Survey NEMSAS National Emergency Medical Services and Ambulance Scheme NHFS National Health Facility Survey NMEP National Malaria Elimination Program NPHCDA National Primary Health Care Development Agency PDO Project Development Objective PHC Primary Health Care PIU Project Implementation Unit PrDO Program Development Objective PVAC Presidential Initiative for Unlocking Healthcare Value Chain RAP Resettlement Action Plan RF Results Framework SBA Skilled Birth Attendance SEA/SH Sexual Exploitation and Abuse/Sexual Harassment WHO World Health Organization Official Use Only The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) @#&OPS~Doctype~OPS^dynamics@restrhybridbasicdata#doctemplate BASIC DATA Product Information Operation ID Operation Name Nigeria: Improved Child Survival Program for Human P167156 Capital MPA Product/Financing Instrument Geographical Identifier Investment Project Financing (IPF) Nigeria Approval Date Current Closing Date 18-Feb-2020 31-Dec-2025 Original EA Category Partial Assessment (B) (PAD Approval Package-18 Feb 2020) Organizations Borrower Responsible Agency Federal Ministry of Health, National Primary Health Care Federal Republic of Nigeria Development Agency (NPHCDA) @#&OPS~Doctype~OPS^dynamics@restrhybridoperationstatus#doctemplate OPERATION STATUS Project Development Objective (DO) Original Development Objective The project development objective (PDO) of the first phase (IMPACT) is to improve the utilization and quality of immunization plus and malaria services in selected states. Disbursement Summary (in USD million) Source of Funds Net Commitment Disbursed Undisbursed % Disbursed IBRD -- -- -- 0 IDA 640.37 559.46 71.01 88.74 Official Use Only i The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Grants -- -- -- 0 Policy Waivers Does this restructuring trigger the need for any policy waiver(s)? No @#&OPS~Doctype~OPS^dynamics@restrhybridmpa#doctemplate MULTIPHASE PROGRAMMATIC APPROACH (MPA) Multiphase Programmatic Approach (MPA) Program Development Objective Original MPA Program Development Objective To reduce under-five mortality rate in program areas Proposed MPA Program Development Objective Multiphase Programmatic Approach (MPA) Status (Public Disclosure) Status and Key Decisions (Public Disclosure) Active @#&OPS~Doctype~OPS^dynamics@restrhybridmpa#doctemplate Official Use Only ii The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) TABLE OF CONTENTS I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING ........................................................................................2 II. DESCRIPTION OF PROPOSED CHANGES ....................................................................................................................5 III. PROPOSED CHANGES ................................................................................................................................................6 IV. DETAILED CHANGE(S) ...............................................................................................................................................7 RESULTS FRAMEWORK................................................................................................................................................11 Official Use Only The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. INTRODUCTION 1. This Restructuring Paper seeks the approval of the Country Director to carry out a restructuring of the first phase of the Nigeria Improved Child Survival Program for Human Capital Multiphase Programmatic Approach (MPA) — the Immunization Plus and Malaria Progress by Accelerating Coverage and Transforming Services Project (IMPACT; P167156), originally approved on February 18, 2020, with a US$650 million allocation. The Program Development Objective (PrDO) of the MPA is to reduce under-five mortality rate in program areas, while the IMPACT Project Development Objective (PDO) is to improve the utilization and quality of immunization plus and malaria services in selected states. 2. Following the Government of Nigeria’s request dated July 21, 2025, this restructuring proposes the following changes to IMPACT (The Project): (a) a first extension of the closing date by 12 months from December 31, 2025 to December 31, 2026; (b) triggering of OP 4.12 (Involuntary Resettlement) to incorporate measures to address Environmental and Social (E&S) Safeguard1 issues identified during the May 2025 implementation support mission, as detailed in the July 27, 2025 Aide Memoire and Implementation Status and Results Report (ISR) dated September 2025; (c) revising component two of the project to expand the use of the investment funds from minor repairs of existing Primary Health Care (PHC) infrastructure to minor rehabilitation/expansion, including demolition or new construction of PHC facilities and health workers training institutions; and (d) updating the Results Framework (RF) to remove duplicate indicators and revise the end date of the Project. B. PROJECT STATUS 3. The IMPACT Project has four components: (1) Malaria Control—US$94.70 million equivalent (14.6 percent); (2) Immunization Plus—US$532 million equivalent (81.8 percent); (3) Knowledge for Change—US$23.3 million equivalent (3.6 percent); and (4) Contingent Emergency Response Component (CERC)—zero allocation. 4. This is the third restructuring of the IMPACT Project. The first restructuring in July 2021 revised Component 2 to include financing for construction of the Lagos Vaccine Hub. In October 2024, a second restructuring updated the RF and reallocated funds across disbursement categories.2 5. The PDO achievement and Implementation Progress were rated moderately satisfactory in the last ISR dated September 2025. Two of the eight PDO indicators have exceeded their end-of-project targets (Long-Lasting Insecticide Treated Net (LLIN) distribution and children under five fully immunized). The remaining six PDO indicators are making solid progress as follows: (a) The number of deliveries assisted by skilled birth attendants have reached 84 percent of the target as of September 2025; (b) Although current (2025) National Health Facility Survey (NHFS) data is unavailable for health facility quality care indicator, 2023 NHFS data shows 92 percent progress toward the goal; and (c) in the absence of 2025 Multiple-Indicator Cluster Survey (MICS), we compared two rounds of the National Demographic and Health Survey (NDHS) data (2018 and 2024) and it shows that, (i) under-five mortality improved from 132 to 110 per 1,000; (ii) fully immunized children rose from 31 percent to 39 percent; (iii) Artemisinin Combination Therapy (ACT) usage increased from 52 percent to 59 percent; and (iv) percentage of deliveries assisted by a skilled birth attendant rose marginally from 43.0 percent to 45.7 percent. This appears to suggest that progress is being made in moving these indicators in the right 1IMPACT Project was processed under the previous World Bank Safeguard Policies. 2First Restructuring 2021 Second Restructuring 2024 Official Use Only Page 2 The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) direction. This progress will be validated when the 2025 MICS is finalized and the report disseminated. Six of the eleven intermediate results indicators (IRIs) have met their end targets, and five IRIs are progressing well. Component progress (as per the September 2025 ISR) is outlined below: Component 1: Malaria Control is satisfactory. All end-of-project IRI targets for this component have been achieved as the project continues to align with national strategies and maintains effective coordination with the National Malaria Elimination Programme (NMEP). Component 2: Immunization Plus is moderately satisfactory. Four out of six indicators were met using routine data sources (District Health Information System 2 (DHIS2) and project report). Currently, 28 states are upgrading 2,625 PHC facilities to Basic Emergency Obstetric and Newborn Care (BEmONC) and Level 2 standards. Approximately, 3,000 skilled birth attendants have been hired, trained, and assigned across 15 states. More than US$6 million was allocated directly to PHC facilities to cover essential drugs, outreach services, skilled birth attendants’ salaries, data reviews, and medical records officers’ data bundles from January to July 2025. To improve financial management, 774 performance financial management officers were recruited, and 600 Samsung tablets with financial applications were distributed and are in use. Over US$170 million in vaccines and cold chain equipment has been procured and is currently being utilized in PHC facilities. Construction of the national cold and dry chain warehouse in Lagos is completed and equipping of the facility is about 95 percent completed, and six haulage firms now support vaccine distribution. Component 3: Knowledge for Change is satisfactory. Monitoring and evaluation improved via the shift to a digital Health Management Information System (HMIS). The monthly summary form is now digital and installed on project-provided laptops at supported facilities. Around 90 percent of these facilities have a medical records officer and have completed digital training. Approximately 6,000 facilities submit monthly reports digitally. Data quality assessments show reporting timeliness above 80 percent and completeness at 93 percent, up from under 60 percent for both. The conduct of the 2025 NHFS and Malaria Indicator Survey (MIS) are on track, with dissemination plan for first quarter of 2026. Component 4: Contingent Emergency Response Component (CERC) (US$0 million equivalent) has not been activated. 6. Monitoring and Evaluation is assessed as moderately satisfactory. Routine HMIS data serves as the primary source for monitoring project performance. To enhance HMIS data quality, the project supports the Federal Ministry of Health (FMoH)’s Department of Health Planning, Research, and Statistics in its ongoing improvement initiatives. With this support, the FMoH conducted a rapid assessment of PHC HMIS. The findings informed the project's strategy to strengthen routine HMIS. At present, all supported facilities are equipped with either a laptop or a tablet to facilitate HMIS reporting. Targeted advocacy and financial support from the project have resulted in nearly 90 percent of facilities appointing dedicated HMIS officers (medical record officers), allowing healthcare providers to focus on patient care instead of reporting duties. In addition, Local Government Health Authorities’ monitoring and evaluation officers have been provided with laptops to support their review of facility-entered data. The 2025 NHFS is proceeding according to plan. Furthermore, the 2025 MICS has commenced, and the dissemination of the report is scheduled for the third quarter of 2026. 7. Overall performance in procurement and financial management is moderately satisfactory. Some State Project Implementation Units (PIUs) experienced issues such as inadequate financial and procurement documentation, unauthorized incentive payments, weak internal controls, incomplete asset registers, low-quality audits, and limited accounting competence. To address these issues, the national PIU with the support of the World Bank organised a meeting with all the State PIUs, and all states have agreed to resolve these issues. Most National Implementing Agencies and State PIUs used standard procurement documents and bid evaluation templates; however, some cases lack report information or criteria. Cluster procurement consultants have been hired to directly support State PIUs, and contract management training is planned to enhance procurement team capacity, especially for accurate documentation updates in the Official Use Only Page 3 The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Systematic Tracking of Exchanges in Procurement (STEP). Overall compliance has generally improved, contributing to enhanced transparency. 8. E&S safeguard performance has been assessed as moderately satisfactory. Currently, approximately 70 percent of rehabilitation/upgrade work at PHC facilities has been completed across the states. However, the World Bank is triggering OP 4.12 (Involuntary Resettlement) due to land acquisitions by 53 PHC facilities in 15 states3 from either the government, communities, families or private individuals. These PHC facilities acquired land because the existing spaces were insufficient to meet Level 2 facility as well as BEmONC requirements, following a recent health sector reform mandating at least one PHC facility per political ward to meet BEmONC standards.4 To comply with this requirement, the scope of the PHC facility upgrades changed from minor rehabilitation and repairs, such as painting, plastering, and replacing doors/windows and leaking roofs of existing buildings, to minor rehabilitation/expansion of existing structures, including demolition/new construction. These changes and acquisition of land will require an update to the agreed Safeguard instruments including the Environmental and Social Management Plan (ESMP). The Integrated Safeguards Data Sheet (ISDS) has been revised and approved by the World Bank. 9. In order to adequately address these land acquisition issues, the World Bank requested the Government of Nigeria in July 2025 to conduct an assessment in accordance with the applicable policies, to determine the geographic locations and ascertain steps taken (a) to avoid and minimize involuntary resettlement; (b) if there have been any forced evictions, mitigate unavoidable adverse social and economic impacts from the land acquisition by providing timely and sufficient compensations for physical and economic displacement; (c) ensure displaced persons were consulted and participated in planning and implementing the resettlement, and were offered support after displacement; and (d) the preparation of the Resettlement Action Plan (RAP). The World Bank reviewed the draft rapid social assessment received on October 3, 2025, provided feedback, and approved the final assessment report submitted to the World Bank on October 21, 2025. The assessment found that land was voluntarily donated in 52 of the PHC facilities and purchased in one. Of the 52 lands that were voluntarily donated; 24 have undocumented land donation agreement, while the other 28 have signed land donation agreements. An action plan (in the rapid social assessment report) and the process of ensuring proper documentation has commenced in all 24 facilities. Five PHCs acknowledged grievances in the land acquisition process, mostly arising from poor land documentation, exclusion of stakeholders from decision-making, or disputes over ownership and transfers. A corrective action plan to address these grievances has been developed (in the rapid social assessment report) and implementation has commenced. A RAP, including provisions for involuntary resettlement has been prepared, cleared by the World Bank, and publicly disclosed by the Government of Nigeria and the World Bank on November 18 and November 28, 2025, respectively, in English5 6. 10. Regarding grievance management, the Project has received 4,991 complaints to date, with 4,838 resolved and 153 currently in progress. Majority of the grievances were around service delivery, and contractor delays. To enhance the handling of grievances—including those related to sexual exploitation and abuse (SEA) and sexual harassment (SH)— facilities are implementing awareness campaigns and providing tools such as toll-free lines, visible signage, and complaint boxes labeled in local languages. 11. Dated Legal Covenants: The Project is in compliance with all dated legal covenants. The convenant regarding appropriation for vaccines from domestic resources is reported annually, and the Government of Nigeria has been meeting 3 Abia, Bauchi, Benue, Cross-River, Ebonyi, Edo, Ekiti, Kogi, Kwara, Nasarawa, Ondo, Oyo, Plateau, Taraba and Yobe 4 WHO identifies seven "signal functions" as international standards for Basic Emergency Obstetric and Newborn Care (BEmONC) to address maternal and newborn mortality. 5 https://ead.gov.ng/public-disclosure-on-the-rap-for-the-impact-project-by-nphcda/ 6 https://documents.worldbank.org/en/publication/documents-reports/documentdetail/099421311282512752 Official Use Only Page 4 The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) its obligations for the previous years. On November 21, 2025, the government of Nigeria released US$46,482,796.42 for vaccines procurement. This is about 45.8 percent of what was budgeted for vaccines procurement in 2025. 12. While the overall project risk rating remains moderate, the country continues to face substantial macroeconomic risks. Nigeria faces macroeconomic challenges, including climate impacts, post-pandemic recovery, ongoing conflicts, and issues in the oil sector, all of which could potentially impact human capital goals. However, these challenges are not expected to directly affect the achievement of the PDO; therefore, the risk is rated as moderate. 13. As of December 4, 2025, the project has disbursed 87.06 percent of the total financing. C. RATIONALE FOR RESTRUCTURING 14. The proposed extension of the closing date by 12 months is necessary (a) to address E&S issues related to Involuntary Resettlement and Voluntary Land Donation that have resulted in expansion of the scope of PHC facility upgrades, identified during the May 2025 implementation support mission and through ongoing engagement with the PIUs, and (b) component 2 is being revised to expand the scope of PHC facility upgrade7 (c) to allow for certain administrative adjustments, such as deleting duplicate indicators and extension of the end date of the indicators. This extension is proposed to ensure continued progress and enhance impact. II. DESCRIPTION OF PROPOSED CHANGES Changes to the IMPACT Project 15. Environment and Social Safeguards. OP 4.12 (Involuntary Resettlement) is triggered as a result of land acquisition by 15 states8. This action was undertaken following the recent health sector reform mandating at least one PHC facility per political ward to meet BEmONC standards. The ISDS has been revised and approved by the World Bank. No other new Safeguard Policies are triggered, and the Safeguard Category remains unchanged. The RAP has been prepared, cleared by the World Bank and was publicly disclosure by the Government of Nigeria and the World Bank on November 18, 2025, and 28, 2025, respectively. The estimated cost for implementation of the RAP in Nigerian Naira is NGN48,826,500.00, equivalent of about US$33,546.209. 16. Extension of the Closing Date. The closing date of the IMPACT Project is December 31, 2025. At the government’s request and to provide sufficient time to implement and monitor the implementation of the RAP and the Voluntary Land Donation protocols, the closing date would be extended to December 31, 2026. Additionally, the Government of Nigeria uses the IMPACT Project to meet its malaria intervention commitments required by the Global Fund. The current Global Fund funding round will end in 2026, thus the proposed extension is necessary to match this timeline, especially since Nigeria has the highest malaria burden globally. The disbursement estimates have also been revised. 17. Expansion of Component 2 activities. Part 2: (a) (i) reads “providing decentralized funding with performance-based allocation for quality improvement directly to PHC facilities to strengthen the provision of immunization services, curative care for children under-five outreach activities, in reproductive, maternal and child health services, skilled delivery, postnatal care, and maintenance and minor repair of existing PHC infrastructure”. This will change to “providing 7 Details of the expansion are in paragraph 17 8 Abia, Bauchi, Benue, Cross-River, Ebonyi, Edo, Ekiti, Kogi, Kwara, Nasarawa, Ondo, Oyo, Plateau, Taraba and Yobe 9 October 24, 2025 (https://www.cbn.gov.ng/rates/ExchRateByCurrency.html) Official Use Only Page 5 The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) decentralized funding with performance-based allocation for quality improvement directly to PHC facilities to strengthen the provision of immunization services, curative care for children under-five outreach activities, in reproductive, maternal and child health services, skilled delivery, postnatal care, and maintenance and minor rehabilitation/expansion, including demolition or new construction”. 18. The Financing Agreement will be amended to include Involuntary Resettlement, extension of the closing date, expansion of component 2 activities and revision of the RF. 19. Revision of the Result framework. The RF is updated to remove duplicate indicators and revise the end date to Dec 31, 2026. (Refer to the attached Results Framework for details). TABLE 1: AGREED ACTION PLAN S/N Action Responsible Timeline 1 Complete ongoing PHC expansion, construction and upgrade in States PIUs February 2026 accordance with the Safeguards requirements 2 Complete all ongoing service provision activities State PIUs September 2026 3 NEMSAS, PVAC, WHO and Complete all NEMSAS, PVAC, WHO and NMEP ongoing activities June 2026 NMEP 4 NMEP, NPHCDA and All PIUs to ensure adequate documentation of their finances 29-Aug-2026 States PIUs 5 Initiate project closure measures for completion of activities, financial National and state PIUs January 2026 management, procurement, E&S and other relevant areas 6 Implementation of the RAP and all the recommended actions in States PIUs March 2026 the social rapid assessment report @#&OPS~Doctype~OPS^dynamics@restrhybridsummarychanges#doctemplate Summary changes III. PROPOSED CHANGES Operation Information Proposed Changes Operation Information Proposed Changes Safeguard Policies Triggered Yes Loan Closing Date Extension Yes ISDS Yes Implementation Schedule Yes Safeguards Oversight Yes Loan Cancellations No Function Results Yes Reallocations No Disbursements Estimates Yes Financial Management No Components Yes Procurement No Development Objective No Institutional Arrangement No EA Category No MFD/PCE No Risks No Official Use Only Page 6 The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Legal Covenants No Conditions No Implementation Modalities No Disbursements Arrangements No DDO No Clients No Appraisal Summary No @#&OPS~Doctype~OPS^dynamics@restrhybriddetailedchanges-disclose#doctemplate IV. DETAILED CHANGE(S) COMPONENTS Current Current Proposed Proposed Cost Action Component Name Cost (USD) Component Name (USD) Component 1:Malaria 94,720,000.00 Revised Component 1:Malaria Control 94,719,000.00 Control Component 2: Immunization Component 2: Immunization 532,000,000.00 Revised 532,001,000.00 Plus Plus Component 3: Knowledge Component 3: Knowledge for 23,280,000.00 No Change 23,280,000.00 for Change Change Component 4: Contingent Component 4: Contingent Emergency Response 0.00 No Change Emergency Response 0.00 Component (CERC) Component (CERC) TOTAL 650,000,000.00 650,000,000.00 COSTS & FINANCING Private Capital Facilitation Is this an MFD-Enabling Project (MFD-EP)? Is this project Private Capital Enabling (PCE)? LOANS Official Use Only Page 7 The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Loan Closing Original Revised Proposed Proposed Deadline Loan/Credit/Trust Status Closing Closing(s) Closing for Withdrawal Fund Applications IDA-65390 Effective 31-Dec-2025 31-Dec-2025 31-Dec-2026 30-Apr-2027 DISBURSEMENTS Operation Dates & Projection Details Reasons to change the full Disbursement date and/or the projection Restructuring Implementation Start Date Operation Closing Date 18-Feb-2020 31-Dec-2025 Projected Date for Full Disbursement 30-Apr-2027 Expected Disbursements (in US $) (Absolute) Original Estimation at Preparation Actual Year Revised Estimation (Approval Package – 18 Feb 2020) FY2020 7,103,850.00 0.00 0.00 FY2021 73,757,450.00 0.00 0.00 FY2022 130,962,650.00 49,969,249.00 49,969,249.00 FY2023 156,038,350.00 99,721,237.13 99,721,237.13 FY2024 127,892,700.00 124,698,477.43 124,698,477.43 FY2025 100,766,900.00 240,892,880.42 240,892,880.42 FY2026 53,478,100.00 104,203,483.11 44,177,986.21 FY2027 0.00 30,514,672.91 0.00 LEGAL Environmental Assessment (EA) Category Change in EA Category? No Safeguard Policies Change in Safeguards Policies Triggered? Yes Official Use Only Page 8 The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Triggered Explanation (required if Proposed rating changes) Policies Current Projects on International No No Waterways (OP) (BP 7.50) Projects in Disputed Area (OP) (BP No No 7.60) The E&S risks associated with the restructuring are similar to the identified risks in the ESMF. The project will not fund any major civil works but only minor rehabilitation of existing buildings and minor construction in facilities that require expansion to meet the minimum standard required for the provision of BEnMOC services. The potential risks and impact of proposed civil works are expected to be minor, site specific and relatively easy to mitigate. Environmental Assessment (OP) These activities will lead to Yes Yes (BP 4.01) environmental and social risks/impacts. Other Activities under the MPA will include vaccination/immunization, distribution of drugs and LLINs that generate healthcare waste such as expired vaccines, sharps and unsafe disposal of used LLINs which pose environmental and health risks. However, in the context of Nigeria, this is of modest environmental concern since the volume of waste from wasted vaccine vials, medications and diagnostics is small and Official Use Only Page 9 The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) because sterilized vaccines and packaged medications do Performance Standards for Private No No Sector Activities OP/BP 4.03 Natural Habitats (OP) (BP 4.04) No No Forests (OP) (BP 4.36) No No Pest Management (OP 4.09) No No Physical Cultural Resources (OP) No No (BP 4.11) Indigenous Peoples (OP) (BP 4.10) No No In the process of upgrading Primary Health Centers, it became necessary that some PHCs acquire additional land. This acquisition was not anticipated during project preparation. The involuntary nature of land take and its Involuntary Resettlement (OP) (BP impact on assets and No Yes 4.12) livelihoods necessitate triggering OP 4.12. A social assessment has been conducted, and a Resettlement Action Plan acceptable to the Bank has been developed by the client. Safety of Dams (OP) (BP 4.37) No No Official Use Only Page 10 The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) RESULTS FRAMEWORK10 @#&OPS~Doctype~OPS^dynamics@restrannexpolicyandresult#doctemplate PDO Indicators by PDO Outcomes Reducing under-5 mortality rate Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year 102 Dec/2021 NA 31-Jul-2025 NA 31-Jul-2025 88 Dec/2026 Revise Under-five mortality rate Comments on achieving targets MICS is the source of the data. The next 2025 MICS is at survey design stage and is expected to be launched in (Number) 2025 -2026. However, data from the 2023-2024 NDHS conducted last year shows improvement in under five mortality. 1. To improve utilization of malaria (preventive and curative) services Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year Revise Number of Long Lasting 0 Dec/2021 3,354,816 31-Jul-2025 3,354,816 31-Jul-2025 2,300,000.00 Dec/2026 Insecticide Nets (LLIN) distributed Comments on achieving targets End of project target exceeded. Data source is: DHIS 2 (Number) Revise Percentage of febrile children 18.10 Dec/2021 NA 31-May-2025 NA 31-May-2025 42.70 Dec/2026 under five in the last two weeks who Comments on achieving targets MICS is the source of the data and there is no recent data. The next round of MICS will be conducted this year. were treated with ACTs However, data from the mid NDHS conducted last year shows improvement in use of ACT for treatment of (Percentage) malaria among febrile children. 2. To improve utilization of immunization plus (immunization, maternal and neonatal) services Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year 5,846,048.00 Dec/2021 13,687,864 31-Jul-2025 13,687,864 31-Jul-2025 9,300,000.00 Dec/2026 10 Revision here refers to revision of the closing date from Dec 2025 to Dec 2026. Page 11 Official Use Only The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Revise Number of children under five Comments on achieving targets End of project target exceeded. Data source: DHIS 2 fully immunized (Number) Revise 1,436,049.00 Dec/2021 4,060,644 31-Jul-2025 4,060,644 31-Jul-2025 5,100,000.00 Dec/2026 Number of deliveries assisted by skilled birth attendants (Number) Comments on achieving targets 81% of project end of project target achieved. Data source: DHIS2 31 Dec/2021 NA 31-May-2025 NA 31-May-2025 36.00 Dec/2026 Revise Percentage of children ages (12- Comments on achieving targets MICS is the source of the data and there is no recent data. The next round of MICS will be conducted this year. 23) months fully vaccinated. However, data from the mid NDHS conducted last year shows improvement in the percentage of children who (Percentage) are fully vaccinated. RevisePercentage of women (15-49) 50.70 Dec/2021 NA 31-May-2025 NA 31-May-2025 58.80 Dec/2026 who had live births in the 2 years Comments on achieving targets MICS is the source data and there is no recent data. The next round of MICS will be conducted this year. preceding the survey who were However, data from the mid NDHS conducted last year shows improvement in SBA deliveries. assisted by a skilled birth attendant during delivery (Percentage) To improve quality of malaria and immunization plus services Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year 39.30 Dec/2021 47.70 19-Jul-2024 47.70 19-Jul-2024 51.90 Dec/2026 Revise Average Health Facility Quality Comments on achieving targets Source of data: NHFS. 2023 target exceeded when 2023 data was used. The end of project target (51.8) is very of Care Score (Percentage) likely to be achieved. Intermediate Results Indicators by Components Component 1:Malaria Control Revised Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year Revise Number of children under 5 10,793,635.00 Dec/2021 24,029,271 31-Jul-2025 24,029,271 31-Jul-2025 15,393,635.00 Dec/2026 presenting with fever and tested for Comments on achieving targets End of project target exceeded. Data source: DHIS 2 malaria (Number) 7,952,433.00 Dec/2021 17,413,795 31-Jul-2025 17,413,795 31-Jul-2025 12,552,433.00 Dec/2026 Page 12 Official Use Only The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Revise Number of children under five Comments on achieving targets End of project target exceeded. Data source: DHIS 2 with confirmed uncomplicated malaria treated with ACTs (Number) Revise 1,703,328.00 Dec/2021 4,740,901 31-Jul-2025 4,740,901 31-Jul-2025 3,303,328.00 Dec/2026 Number of Pregnant women who receive IPT 3 (Number) Comments on achieving targets This indicator is repeated and should be kept. End of project target exceeded. Data source: DHIS 2 Component 2: Immunization Plus Revised Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year Revise People who have received 7,282,079.00 Dec/2021 17,548,528 31-Jul-2025 17,548,528 31-Jul-2025 14,200,000.00 Dec/2026 essential health, nutrition, and Comments on achieving targets End of project target exceeded. Data source: DHIS 2 population (HNP) services (Number) Revise People who have 4,813,553.00 10,904,596 10,904,596 9,130,000.00 received essential health, Comments on achieving targets End of project target exceeded. Data source: DHIS 2 nutrition, and population (HNP) services - Female (RMS requirement) (Number) Revise Percentage of facilities receiving 0 Dec/2021 100 03-Aug-2025 100 03-Aug-2025 100 Dec/2026 DFF with engagement of ward Comments on achieving targets Target achieved. Data source: Project report development committee for facility managemen (Percentage) Revise Percentage of children ages (12- 58.30 Dec/2021 NA 31-May-2025 NA 31-May-2025 59.80 Dec/2026 23) months vaccinated with the 3rd Comments on achieving targets MICS is the source data and will be available before the end of the year. dose of Pentavalent Vaccine (Percentage) Revise Proportion of annual vaccine 28.00 Dec/2021 NA 31-May-2025 NA 31-May-2025 82.20 Dec/2026 procurement expenditure released Comments on achieving targets Data will be available by Dec 2025 from government budgetary resources (Percentage) 0.00 Dec/2019 50.00 07-Jun-2024 50.00 07-Jun-2024 50.00 Dec/2026 Page 13 Official Use Only The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Revise Percentage increase in Comments on achieving targets This indicator was achieved. performance framework score of federal and state PIUs in immunization plus states (Percentage) Revise Percentage of newborns that 3.80 Dec/2021 NA 31-May-2025 NA 31-May-2025 4.30 Dec/2026 received postnatal care within 3-6 Comments on achieving targets MICS is the source data. Will be available before the end of the year. days of delivery (Percentage) Component 3: Knowledge for Change Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year Percentage of public health facilities 29.50 Dec/2021 32.80 30-Sep-2024 32.80 30-Sep-2024 41.70 Dec/2026 with safe disposal of sharps waste in Comments on achieving targets 2024 target almost achieved even when 2023 data was used. The project end of project target (41.5) is very Malaria/ immunization plus states likely to be achieved. (Percentage) Percentage of facilities where a copy 16.20 Dec/2021 23.60 19-Jul-2024 23.60 19-Jul-2024 41.40 Dec/2026 of the checklist was left at the facility Comments on achieving targets The next round of the survey is 2025. There is likelihood that the end of project target will be achieved. for the most recent integrated supportive supervision (ISS) visit (Percentage) Primary Health Facility Health 45.40 Dec/2021 76.40 19-Jul-2024 76.40 19-Jul-2024 55.50 Dec/2026 Workers’ Knowledge of IMCI Key Comments on achieving targets End of project target exceeded even when 2023 data was used. danger signs and main symptoms in Malaria/Immunization plus states (Percentage) Semi-annual nationwide LQAS 0.00 Dec/2019 5.00 07-Jun-2024 5.00 07-Jun-2024 10.00 Dec/2026 surveys conducted and disclosed Comments on achieving targets This is indicator was remove during the October 2024 project restructuring as it was no longer needed to track publicly (Number) the project performance. Percentage of facilities where a copy 16.20 Dec/2019 16.20 12-Aug-2022 16.20 12-Aug-2022 41.20 Dec/2025 of the checklist was left at the facility Comments on achieving targets Percentage of facilities where a copy of the checklist was left at the facility for the most recent ISS visit in for the most recent ISS visit malaria and immunization plus states. The baseline for this indicator was based on the National Health Facility (Percentage) Survey 2016.ndicator will be updated when the repeat survey is conducted in 2023. Page 14 Official Use Only The World Bank Nigeria Improved Child Survival Program for Human Capital MPA (P167156) Page 15 Official Use Only