@ The World Bank Report No: ISR5828

Implementation Status & ResultsCongo, Republic of

Health Sector Services Development (P106851)

o0C Operation Name: Health Sector Services Development (P106851) Project Stage: Implementation Seq.No: 9 Status: ARCHIVED Archive Date: 05-Nov-2011

Country: Congo, Republic of Approval FY: 2008

6 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan

0.U) Implementing Agency(ies): MEPSA

O Key Dates

Board Approval Date 29-May-2008 Original Closing Date 29-May-2012 Planned Mid Term Review Date 21-Apr-2011 Last Archived ISR Date 05-Nov-201 1

Effectiveness Date 02-Feb-2009 Revised Closing Date 29-May-2012 Actual Mid Term Review Date 23-May-2011

Project Development Objectives

Project Development Objective (from Project Appraisal Document)

The development objective of the project is to support the strengthening of the health system in order to effectively combat the major communicable diseases andimprove access to quality services for women, children and other vulnerable groups. Within the comprehensive sector development program of the PNDS, the IDAsupported project will focus primarily on strengthening sector stewardship, fiduciary systems and monitoring and evaluation (Componentl); human resources(Component 2); Infrastructure assessment, mapping and comprehensive rehabilitation plan, including limited construction (Component 3) and, delivery of Package ofEssential Services (PSE), with emphasis on Malaria HIV/AIDS and MCH, pharmaceuticals management, community participationlindigenous peoples and equity(Component 4).

Has the Project Development Objective been changed since Board Approval of the Project?

Q Yes ® No

Component(s)

Component Name Component Cost

Component 1: Strengthening leadership capacities in managing a functioning and decentralized 10.20health system.

Component 2: Institution of an efficient and effective system for managing health sector human 0.800a resources0U Component 3: Rehabilitation and equipment of health facilities 2.30

' Component 4: Improvement of access to a package of quality essential health services 23.900

P RuOverall Ratings

Previous Rating Current Rating

-Q Progress towards achievement of PDO Moderately Unsatisfactory Moderately Satisfactory

Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory

Overall Risk Rating

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) The World Bank Report No: ISR5828

Implementation Status OverviewThe June 2011 project midterm review provided an opportunity to carry out a candid assessment of the implementation status and to agree upon a set of benchmarks to be met andon a series of activities to be implemented within the coming months the majority of which have been accomplished. Project implementation has progressed and disbursement is nowat 48% from 15% in March 2011 and 6% in November 2010. Thus the project has essentially disbursed almost half of the funds in one year. Disbursement has been on high impact

o activities such as procurement and distribution of bed nets, the provision of medical equipment for health centers and the support to the ongoing DHS. It is expected to continuea progressing during the next 3 months as some new important activities such as the PBF pilot are being launched. Key project inputs, such as Long Lasting Insecticide-treated bedb nets had suffered initial delays due to poor planning -and lack of experience in mass distribution, but have now been completed in 6 departments. The contract with MACROo International to carry out a Demographic and Health Survey (DHS) has been signed and data collection is currently being carried out with a preliminary report to be completed in0 February 2012. The hiring of a health services purchasing agent, of a monitoring agency and of a training agent to implement a large Performance-Based Financing (PBF) pilot hasF been completed with contracts signed.. The project has also completed a census of health staff and data are being analyzed. A large UNFPA designed survey on obstetrical and.0 neonatal care is also planned but implementation has been delayed because of last minute contract modifications required by UNFPA . The project continues to receive full support-Q of the Cabinet.. In addition the Ministry is currently revising its National Health Plan (2011-2014) and has began collecting data to complete a "carte sanitaire" ( health facilities map)0- World Bank follow-up supervision missions took place in July and September 2011 and December 2011.

Locations

No Location data has been entered

Results

Project Development Objective Indicators

Indicator Name Core Unit of Measure Baseline Current End Target

% of caretakers of children under 5 Text Value Not available NAexperiencing illness in the previous 2 weeks Date 12-Apr-2008 15-Jun-2010 29-May-2012reporting cost as a barrier to seeking facility-rei cot alComments No baseline. Need DHS or NA. Need DHS or MICS (DHS Moving targetbased caref j CS(S 0)MICS (DHS in 2011) planned for 2011-2012)% of children under 5 years of age who slept Text Value 6% 60%under an ITN the previous night Date 12-Apr-2008 01-Sep-2010 29-May-2012

Comments NA. Need community-basedsurvey or DHS (2012 DHS).

% of households owning 2 or more ITNs Text Value 4% 60%

Date 12-Apr-2008 15-Jul-2011 29-May-20120Comments NA. Likely to be less than

10%. To be checked after,distribution in October 2011o

0 % of births attended by skilled personnel Text Value 86% 90%O Date 12-Apr-2008 15-Jun-2011 29-May-2012

Comments NA

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@ The World Bank Report No: ISR5828

% of facilities (by type) with HR according to Text Value 20% 50%norms (by type of personnel) Date 12-Apr-2008 15-Jul-2011 29-May-2012

Comments NA, baseline questionable.

Immunization DPT3/Penta under-1 (number of Text Value 66% 90%0 children per year) Date 12-Apr-2008 15-Jun-2010 29-May-2012

Comments Source: EPI unit. Update JulyJ2 2011. Needs to be validated.LD by coverage surveyo % of pregnant women HIV positive placed on Text Value 60% 60%

ARV. Date 12-Apr-2008 15-Jul-2011 29-May-2012

Comments Source: PMTCT program.

% children under five years of age with fever Text Value 15% 50%accessing an effective antimalarial within 24 Date 12-Apr-2008 15-Feb-2011 29-May-2012hours of onset of symptoms Comments Not available and will not be

available without 2012 DHS

Number DDS who develop and submit Text Value 4 12trimester report. Date 12-Apr-2008 15-Feb-2011 29-May-2012

Comments Source: MoH report.

% CSI/CSS/DDS with staff trained in budgeting Text Value 20% 100%and planning Date 12-Apr-2008 15-Jul-2011 29-May-2012

Comments baseline seems very The MoH financial resourcesapproximate and source is department unit trained theunknown DDS on budgeting and

planning.

% of DDS and facilities receiving their budget Text Value 0 100in timely manner Date 15-Jul-2011 29-May-2012

Comments No baseline available. Budget received but with norelation to the real needs

0O Intermediate Results Indicators

Indicator Name Core Unit of Measure Baseline Current End Target0-Z Pregnant women living with HIV who received Number Value 0.00 72.00 80.00U) antiretrovirals to reduce the risk of MTCT Date 12-Apr-2008 15-Jul-2011 29-May-2012

L) Comments Source: National HIV/AIDSprogram Control. Next updateNov 2011.

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@ The World Bank Report No: ISR5828

Long-lasting insecticide-treated malaria nets Number Value 0.00 700000.00 2300000.00purchased and/or distributed Date 12-Apr-2008 15-Feb-2011 29-May-2012

Comments Delays in payment andC. delivering. DistributionOo expected to take place May-

June 2011, taking place inSeptember-October

0- Children receiving a dose of vitamin A Number Value 0.00 178992.00 0.00

Date 12-Apr-2008 15-Jun-2010 29-May-2012

Comments

0 Pregnant women receiving antenatal care Number Value 0.00 70.00 0.00during a visit to a health provider Date 12-Apr-2008 15-Jun-2011 29-May-2012

Comments Source: Maternal health TTL to provide data afterdepartment report. Next MTR.update July 2011no update

Children immunized Number Value 0.00 89.20 0.00

Date 12-Apr-2008 15-Sep-2011 29-May-2012

Comments Source: EPI ( Expanded TTL to provide data afterProgram of Immunization) MTR.report. Most likelyoverestimated

Health facilities constructed, renovated, and/or Number Value 0.00 0.00 0.00equipped Date 12-Apr-2008 15-Jun-2010 29-May-2012

Comments The situation analysis has Data to be provided afterbeen done in 44 health MTR.facilities. Report not yetcompleted.

Number of DDS/CSS who submitted a costed Text Value 6 12>1 annual work plan according to the guidelines Date 12-Apr-2008 30-Sep-2010 29-May-2012o by the deadline.0 Comments Source: MOH (DGS) report.

Pharmaceuticals and medical equipment Text Value

U procured (US$)-Z- Baseline, progress and target data to be inputSB rtComments NA. Progress and target date Source: National Health

Sin next ISR to be provided with next ISR Budget. Gov. gave anamount of US$20 mil. for ARTand essential drugs. Thiscategory of drugs is freeprovided to PLWA ( ART),

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The World Bank Report No: ISR5828

pregnant women and childrenunder five years old ( malariadrugs).The government gave anamount of twenty million

0 dollars for ART and essentialdrugs. This categoryof drugsis free provide to PLWA

0 (ART), pregnant women andchildren under five years old( malaria drugs)

5 Number of facilities offering VCT. Text Value 66 85

Date 12-Apr-2008 15-Sep-2011 29-May-2012

Comments Source: National HIV/AIDSControl Program

% pregnant women receiving 2 doses of IPT Text Value 3.1% 50%

Date 12-Apr-2008 30-Sep-2010 29-May-2012

Comments

Number of sentinel sites (CSS) reporting Text Value 0 6complete and timely data (to be specified) Date 12-Apr-2008 01-Sep-2011 29-May-2012

Comments Not yet available.

Data on Financial Performance (as of 15-Feb-2012)

Financial Agreement(s) Key Dates

Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date

P106851 IDA-H3930 Effective 29-May-2008 18-Jul-2008 02-Feb-2009 29-May-20 12

Disbursements (in Millions)

Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed

P106851 IDA-H3930 Effective XDR 24.30 24.30 0.00 12.16 12.14 50.000

U) Disbursement Graph00

.U

0

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The World Bank Report No: ISR5828

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E

Key Decisions Regarding Implementation

World Bank country and sector management will continue to monitor implementation very closely. The Bank task team is pleased with the progress achieved since the Mid TermReview and will continue to support implementation through monthly visits and regular dialogue with the government in Brazzaville. Finally, the Ministry will ensure that key activitieswith a direct impact on population's health will be implemented, and in particular the mass distribution of bed nets and an increase in vaccination coverage.

Restructuring History

There has been no restructuring to date.

Related Projects

00Theeaae-n rlatd-pojets

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