The World Bank Report No: ISR12379 Implementation Status & Results Timor-Leste Health Sector Strategic Plan Support Project (P104794) Public Disclosure Copy Operation Name: Health Sector Strategic Plan Support Project (P104794) Project Stage: Implementation Seq.No: 11 Status: ARCHIVED Archive Date: 14-Mar-2014 Country: Timor-Leste Approval FY: 2008 Product Line: IBRD/IDA Region: EAST ASIA AND PACIFIC Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 13-Dec-2007 Original Closing Date 30-Jun-2013 Planned Mid Term Review Date 18-Jul-2010 Last Archived ISR Date 11-Aug-2013 Effectiveness Date 17-Jun-2008 Revised Closing Date 15-Jun-2015 Actual Mid Term Review Date 18-Jul-2010 Project Development Objectives Health Sector Strategic Plan Support Project (P104794) Project Development Objective (from Project Appraisal Document) The revised PDO is to support Government of Timor-Leste to get more resources to where they are needed most to improve the deliveryof health services in districts and subdistricts. Has the Project Development Objective been changed since Board Approval of the Program? ● Yes No Component(s) Component Name Component Cost Health Service Delivery (to close out given restructured components below) 9.00 Support Services (to close out given restructured components below) 9.00 Coordination, Planning & monitoring (to close out given restructured components below) 1.70 Innovation and Program Development (to close out given restructured components below) 1.30 New per PP Jan2013: Improving Public Financial Management and Fund Flows for Health Service 12.20 Public Disclosure Copy Delivery New per PP Jan2013: Strengthening Pharmaceutical and Medical Supplies Management 1.60 NEW per PP Jan2013: Improving Evidence-Informed Decision Making and Health Sector 3.90 Coordination Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Unsatisfactory Moderately Unsatisfactory Page 1 of 5 The World Bank Report No: ISR12379 Previous Rating Current Rating Overall Risk Rating Substantial Substantial Public Disclosure Copy Implementation Status Overview Following the September 2013 mission, implementation progress of the restructured project is mixed. Though there is good progress on national health sector monitoring and evaluation framework development, operating costs flow for the community health outreach program (SISCa) service delivery, and the decision to use the Civil Service Commission’s Project Management Information System as the core database for Human Resources Management, there are delays on public financial management (PFM) for improved strengthening the health system and delivery of services; however, this is now moving with PFM experts on board. Stock out rates of tracer essential drugs is a serious concern, though the pharmaceutical agency (SAMES) has recently received a large amount of drugs. The logistical management system to monitor inventory is not widely used and requires intensive effort to log in all drugs received and distributed. Efforts are being made to move implementation forward, particularly for PFM related activities, with key activities being launched early January 2014. With regard to stock out rates, a systematic review and mapping of pharmaceutical supply chain management is being supported by technical assistance. The aim of that assistance is to develop a logistical system which will allow for tracking of pharmaceutical supplies in the warehouse for both incoming purchases and outgoing distribution, and avoid stock outs at the district level. In addition, training and capacity building is being strengthened around logistic management information systems, improve managerial practices and overall inventory management and distribution of drugs to health facilities. Locations Country First Administrative Division Location Planned Actual Timor-Leste Not Entered Democratic Republic of Timor-Leste ✔ Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of districts that receive recurrent Number Value 0.00 0.00 8.00 expenditures consistent (+/- 20%) with the Date 31-Dec-2012 26-Dec-2013 15-Jun-2015 NHSSP MTEF and approved budget Comments No MTEF for NHSSP MTEF has not been launched. available Public Disclosure Copy Number of districts that report expenditure Number Value 0.00 0.00 8.00 against the approved plan/budget on time Date 31-Dec-2012 26-Dec-2013 15-Jun-2015 Comments Reporting & management has Ongoing process to put in been done centrally place structure/system under PFM. Percentage of stock-outs of tracer essential Percentage Value 40.00 50.00 30.00 drugs at health facilities Date 31-Dec-2012 31-Oct-2013 15-Jun-2015 Page 2 of 5 The World Bank Report No: ISR12379 Comments Proxy data from 3 districts There is no accurate way to survey in 2011 measure stockouts which differs between SAMES and Dept of Pharmacy; the Public Disclosure Copy warehouse is currently fully stocked and distribution being made. Joint annual sector review and planning Text Value No Yes Yes meetings held as planned (at least 1/year) Date 31-Dec-2012 20-Sep-2013 15-Jun-2015 Comments Sept mission was a joint annual sector review and planning meeting. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of formal MOH-private sector/NGO Text Value 0 - project 1 - total 6 10 contracts signed Date 30-Dec-2006 26-Dec-2013 30-Jun-2013 Comments 6 contracts signed; All NGO contract ended in June 2012. Health MTEF prepared based on costing of Text Value METF based on the new Not yet undertaken. Available and updated strategic plan strategic plan (i.e., NHSSP) not available Date 31-Dec-2012 26-Dec-2013 15-Jun-2015 Comments Not yet undertaken. Number of districts that submit annual district Number Value 0.00 0.00 9.00 plan/budget to the Central MoH for approval on Date 31-Dec-2012 26-Dec-2013 15-Jun-2015 time Comments No update. Number of structured sector coordination Number Value 0.00 0.00 2.00 meetings held to progress toward one plan, Date 31-Dec-2012 26-Dec-2013 15-Jun-2015 one budget, and one sector M&E framework Public Disclosure Copy Comments No update. Percentage of targeted staff who pass Percentage Value 0.00 0.00 60.00 competency test in financial management, Date 31-Dec-2012 26-Dec-2013 15-Jun-2015 procurement, and/or management Comments No update. Percentage of stock-outs of tracer essential Percentage Value 19.00 50.00 15.00 drugs at SAMES Date 31-Dec-2012 31-Oct-2013 15-Jun-2015 Comments Page 3 of 5 The World Bank Report No: ISR12379 Percentage of SAMES’ procurement activities Percentage Value 47.00 0.00 30.00 using direct contracting (emergency order, in $ Date 31-Dec-2012 26-Dec-2013 15-Jun-2015 value) Comments Procurement is now being Public Disclosure Copy undertaken by MOH, and is not fully transparent. Number of targeted places (13 districts and 6 Number Value 0.00 0.00 11.00 hospitals) with functional National Logistics Date 31-Dec-2012 30-Jun-2013 15-Jun-2015 Management Information System Comments Not available at this time. A computerized drug registration system Text Value No computerized system Not available at this time. Functional system available available Date 31-Dec-2012 26-Dec-2013 15-Jun-2015 Comments Percentage of research projects approved by Percentage Value 0.00 0.00 60.00 the research cabinet that responds to the Date 31-Dec-2012 26-Dec-2013 15-Jun-2015 national research priorities defined by the MoH Comments N/A Activity delayed. Data on Financial Performance (as of 17-Dec-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P104794 IDA-H3430 Effective 13-Dec-2007 16-Apr-2008 17-Jun-2008 30-Jun-2013 15-Jun-2015 P104794 TF-91653 Effective 25-Mar-2008 25-Mar-2008 25-Mar-2008 30-Jun-2013 15-Jun-2015 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P104794 IDA-H3430 Effective USD 1.00 1.00 0.00 0.99 0.00 99.00 P104794 TF-91653 Effective USD 34.20 34.20 0.00 18.99 15.21 56.00 Public Disclosure Copy Disbursement Graph Page 4 of 5 The World Bank Report No: ISR12379 Public Disclosure Copy Key Decisions Regarding Implementation An in-depth review will be carried out in late March 2014 at the next Joint Partner mission. Restructuring History Level two Approved on 05-Mar-2012 Related Projects P144520-Health Sector Strategic Plan Support Additional Financing Public Disclosure Copy Page 5 of 5