The World Bank Implementation Status & Results Report Institutional Foundations to Improve Services For Health (P169641) Institutional Foundations to Improve Services For Health (P169641) WESTERN AND CENTRAL AFRICA | Liberia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 4 | ARCHIVED on 28-Jul-2022 | ISR51815 | Implementing Agencies: Government of Liberia, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 21-May-2020 Effectiveness Date: 02-Feb-2021 Planned Mid Term Review Date: 17-Jun-2024 Actual Mid-Term Review Date: Original Closing Date: 31-Aug-2026 Revised Closing Date: 31-Aug-2026 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To improve health service delivery to women, children and adolescents in Liberia. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Improved service delivery:(Cost $68000000.00 M) Component 2: Institutional strengthening to address key binding constraints:(Cost $11000000.00 M) Component 3: Project Management:(Cost $5000000.00 M) Component 4: Contigency Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The project was approved on May 21, 2020, and became effective on February 2, 2021. However, implementation delays have persisted, and this could be attributed to: (i) delayed completion of Phase 1 construction works at the New Redemption Hospital financed through the Ebola Emergency Response Project (EERP, P152359); and (ii) a halt in the implementation of project activities (except for performance-based financing (PBF)) until after the additional financing (AF) and restructuring is finalized. Further, about 65% (US$35 million) of the total funds under the project are allocated for civil works, and procurement and installation of equipment at the New Redemption Hospital. The civil works under Phase 1 of the construction are funded through the EERP but have not been completed. This has affected progress under the IFISH project. PBF funds under the project are being relied upon to sustain implementation of key activities in the health sector. The PBF scheme under the project covers eight hospitals and 63 primary health facilities in three counties, namely: Gbarpolu, Sinoe, and Rivercess. This represents 26 percent (1,338,007) of the total population (5,180,208) of Liberia in 2021. The PBF has been instrumental in sustaining the gains which were achieved 7/28/2022 Page 1 of 9 The World Bank Implementation Status & Results Report Institutional Foundations to Improve Services For Health (P169641) under the World Bank-supported Liberia Health Systems Strengthening Project (HSSP, P128909). While the COVID-19 has negatively affected health service delivery in Liberia, the impact has been minimal in areas implementing PBF. The average quality scores at the 63 primary health facilities and eight hospitals implementing PBF has been sustained at around 70 percent and 80 percent, respectively. However, the resources for PBF under the project have been exhausted. To mitigate gaps in PBF implementation, the AF and restructuring will help to sustain and expand coverage of PBF. The World Bank and the Ministry of Health have agreed on key areas for the AF and restructuring of the IFISH. It is anticipated that the AF and restructuring will facilitate systems strengthening, improved service delivery, and achievement of better health and nutrition outcomes. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Low Low Low Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes To improve health services to women, children and adolescents in Liberia IN01152320 ►Redemption Hospital Phase 1 and 2 fully completed and operational to provide comprehensive services to women, children and adolescents (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 This target is not due yet. Comments: 7/28/2022 Page 2 of 9 The World Bank Implementation Status & Results Report Institutional Foundations to Improve Services For Health (P169641) IN01152341 ►Pregnant women with 4 antenatal care visits (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 38.97 42.00 44.00 58.24 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 IN01152342 ►Proportion of new users of modern contraception who are adolescents (10-19 years) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 30.61 31.00 35.00 44.19 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 IN01152343 ►Institutional deliveries attended by skilled birth attendant (MD, PA, RN, registered/certified midwife) (disaggregated by age group) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.76 59.00 64.00 76.75 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 IN01152344 ►Adolescent girls (10-19 years) leaving selected health facilities with 2 counselling sessions on family planning (Percentage, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40.00 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 28-Aug-2026 No data is available on this indicator. This indicator is considered to be revised under the upcoming Comments: Additional Financing and restructuring of the IFISH. Intermediate Results Indicators by Components Component 1: Improved service delivery IN01152345 ►Redemption Hospital Phase 1 - Fully Equipped (Date, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 03-Aug-2020 01-Jan-2021 15-Jun-2022 21-Dec-2021 Date 03-Aug-2020 01-Sep-2020 15-Jun-2022 21-Dec-2021 IN01152348 ►Redemption Hospital Phase 1 - Operational (Date, Custom) 7/28/2022 Page 3 of 9 The World Bank Implementation Status & Results Report Institutional Foundations to Improve Services For Health (P169641) Baseline Actual (Previous) Actual (Current) End Target Value 03-Aug-2020 01-Jan-2021 15-Jun-2022 30-Apr-2022 Date 03-Aug-2020 01-Sep-2020 15-Jun-2022 30-Apr-2022 IN01152351 ►Redemption Hospital Phase 2 - Construction Completed (Date, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 03-Aug-2020 01-Jan-2021 15-Jun-2022 30-Sep-2025 Date 03-Aug-2020 01-Sep-2020 15-Jun-2022 30-Sep-2025 IN01152354 ►Redemption Hospital Phase 2 - Fully Equipped (Date, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 03-Aug-2020 01-Jan-2021 15-Jun-2022 30-Apr-2026 Date 03-Aug-2020 01-Sep-2020 15-Jun-2022 30-Apr-2026 IN01152356 ►Redemption Hospital Phase 2 - Operational (Date, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 03-Aug-2020 01-May-2026 15-Jun-2022 31-Aug-2026 Date 03-Aug-2020 01-Sep-2020 15-Jun-2022 31-Aug-2026 IN01152358 ►Number of identified hospitals/HCs with a paediatrician and obstetrician (the first cohort of specialist will incrementy be provided through the Bank financing to the postgraduate education progra (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 6.00 0.00 0.00 25.00 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 28-Aug-2026 No data is available on this indicator in the DHIS2. This indicator is considered to be revised under the Comments: upcoming Additional Financing and restructuring of the IFISH. IN01152360 ►Availability of essential drugs/supplies in identified hospitals/health centers providing caesarian section (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 36.00 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 28-Aug-2026 Data not available from the HMIS. Data will be extracted from the eLMIS and provided in the next ISR. Comments: IN01152363 7/28/2022 Page 4 of 9 The World Bank Implementation Status & Results Report Institutional Foundations to Improve Services For Health (P169641) ►Health facilities certified (quality) to provide maternal, newborn, child and adolescent health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 28-Aug-2026 The Family Health Division at the MoH will be given the responsibility to certify the 25 hospitals and health centers, based on a pre-defined, standardized protocol. However, the standardized protocol for Comments: certification has not been developed yet. Component 2: Institutional strengthening to address key binding constraints IN01152346 ►Number of quarterly Country Platform meetings held to discuss key indicator report and decisions with minutes available (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 1.00 4.00 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 IN01152349 ►Number of complete and timely monthly narrative reports available (per hospital) from 25 identified Hospitals/Health Centers providing cesarean section services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 12.00 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 IN01152352 ►Percentage of counties with <15% drug variance between allocated & distributed (Percentage, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 Data has not yet been complied. Data not available from the HMIS. Data will be extracted from the eLMIS Comments: and provided in the next ISR. IN01152355 ►Annual report available from HR database reporting recruitment, transfers, and disciplinary action taken during previous year (Yes/No, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 IN01152357 ►Citizen feedback mechanism implemented and report discussed in the HSCC, and publicly available in all identified Hospitals/Health centers providing C-Section with minimum staff (Yes/No, Custom, PBC) 7/28/2022 Page 5 of 9 The World Bank Implementation Status & Results Report Institutional Foundations to Improve Services For Health (P169641) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 The Project specific GRM has not been established yet. Comments: IN01152359 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 485,050.00 485,050.00 923,011.00 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 IN01152361 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100,538.00 185,223.00 923,011.00 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 IN01152362 ►Number of students counselled by female counselors in high schools (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 Component 3: Project Management IN01152347 ►Regular reporting on GBV action plan implementation (any changes in the GBV action plan will be notified to the Bank and recorded) (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 IN01152350 ►PIU monitors the independent verification agency for DLI and PBF (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 The reported progress is only on PBF and not the DLIs. Comments: 7/28/2022 Page 6 of 9 The World Bank Implementation Status & Results Report Institutional Foundations to Improve Services For Health (P169641) IN01152353 ►PIU maintains essential staff in these position throughout project implementation, and reports to the Bank (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 03-Aug-2020 31-Oct-2021 15-Jun-2022 31-Aug-2026 Performance-Based Conditions IN01152364 ►PBC 1 Number of quarterly Country Platform meetings held to discuss key indicator report and decisions with minutes available (Number, Process, 1,000,000.00, 1.85%) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 0.00 1.00 -- Date -- 31-Oct-2021 15-Jun-2022 -- IN01152365 ►PBC 2 Percentage of counties with <15% drug variance between allocated & distributed (Percentage, Outcome, 500,000.00, 0.92%) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 0.00 0.00 -- Date -- 31-Oct-2021 15-Jun-2022 -- IN01152366 ►PBC 3 Annual report available from HR database reporting recruitment, transfers, and disciplinary action taken during previous year (Yes/No, Outcome, 2,000,000.00, 3.7%) Baseline Actual (Previous) Actual (Current) Year 5 Value No No Yes -- Date -- 31-Oct-2021 15-Jun-2022 -- IN01152367 ►PBC 4 Number of students counselled by female counselors in high schools (Number, Output, 1,000,000.00, 1.85%) 7/28/2022 Page 7 of 9 The World Bank Implementation Status & Results Report Institutional Foundations to Improve Services For Health (P169641) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 0.00 0.00 -- Date -- 31-Oct-2021 15-Jun-2022 -- IN01152368 ►PBC 5 Citizen feedback mechanism implemented and report discussed in the HSCC, and publicly available in all identified Hospitals/Health centers providing C-Section with minimum staff (Yes/No, Output, 500,000.00, 0.92%) Baseline Actual (Previous) Actual (Current) Year 5 Value No No No -- Date -- 31-Oct-2021 15-Jun-2022 -- IN01152369 ►PBC 6 Adolescent girls (10-19 years) leaving selected health facilities with 2 counselling sessions on family planning (Percentage, Outcome, 1,000,000.00, 1.85%) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 0.00 0.00 -- Date -- 31-Oct-2021 15-Jun-2022 -- Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P169641 IDA-66460 Effective USD 54.00 54.00 0.00 2.59 51.41 4.8% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P169641 IDA-66460 Effective 21-May-2020 14-Jun-2020 02-Feb-2021 31-Aug-2026 31-Aug-2026 Cumulative Disbursements 7/28/2022 Page 8 of 9 The World Bank Implementation Status & Results Report Institutional Foundations to Improve Services For Health (P169641) Restructuring History There has been no restructuring to date. Related Project(s) P177050-Additional Financing for Institutional Foundations to Improve Services for Health 7/28/2022 Page 9 of 9