World Bank Documentdocuments.worldbank.org/curated/en/265521553250305515/...Maternal and Child...

The World BankMaternal and Child Nutrition and Health Results Project (P143650)

REPORT NO.: RES35828

RESTRUCTURING PAPER

ON A

PROPOSED PROJECT RESTRUCTURING

OF

MATERNAL AND CHILD NUTRITION AND HEALTH RESULTS PROJECT

APPROVED ON MARCH 21, 2014

TO

THE REPUBLIC OF THE GAMBIA

HEALTH, NUTRITION & POPULATION

AFRICA

Regional Vice President: Hafez M. H. Ghanem Country Director: Louise J. Cord

Senior Global Practice Director: Timothy Grant EvansPractice Manager/Manager: Gaston Sorgho

Task Team Leader: Samuel Lantei Mills

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ABBREVIATIONS AND ACRONYMS

ANC Antenatal careBFCI Baby-Friendly Community InitiativeCCT Conditional cash transferCPF Country Partnership FrameworkDCD Department of Community DevelopmentDHS Demographic and Health SurveyFNS Food and Nutrition SecurityHCWM Health Care Waste ManagementHCWMP Health Care Waste Management PlanIMAM Integrated Management of Acute MalnutritionM&E Monitoring and EvaluationMICS Multiple Indicator Cluster SurveyMOFEA Ministry of Finance and Economic AffairsMOH Ministry of HealthMoU Memorandum of UnderstandingNaNA National Nutrition AgencyPBF Performance-based financingPCU Project Coordination UnitPDO Project development objectivePHC Primary health carePIC Project Implementation CommitteeQoC Quality of careRBF Results based financingRCH Reproductive and Child HealthRHD Regional Health DirectoratesRTF Regional Task ForcesSBCC Social and behavior change communicationTWG Technical working groupUCT Unconditional Cash TransfersWB World BankWHO World Health OrganizationVAS Vitamin A SupplementationVSG Village Support Group


BASIC DATA

Product Information

Project ID Financing Instrument

P143650 Investment Project Financing

Original EA Category Current EA Category

Partial Assessment (B) Partial Assessment (B)

Approval Date Current Closing Date

21-Mar-2014 31-Jul-2021

Organizations

Borrower Responsible Agency

The Republic of The Gambia National Nutrition Agency (NaNA)

Project Development Objective (PDO)

Original PDOA. Proposed Development Objective

The development objective of the project is to increase the utilization of communitynutritionand primary maternal and child health services in selected regions in the Recipient’s territory.OPS_TABLE_PDO_CURRENTPDOSummary Status of Financing

Ln/Cr/Tf Approval Signing Effectiveness ClosingNet

Commitment Disbursed Undisbursed

IDA-59420 09-Jan-2017 03-Feb-2017 06-Apr-2017 31-Jul-2021 3.20 0 3.36

IDA-D1600 09-Jan-2017 03-Feb-2017 06-Apr-2017 31-Jul-2021 4.30 4.50 .04

IDA-56230 24-Apr-2015 04-Jun-2015 30-Nov-2015 31-Jul-2021 2.48 2.48 .07

IDA-D0500 24-Apr-2015 04-Jun-2015 30-Nov-2015 31-Jul-2021 2.53 2.53 0


IDA-H9230 21-Mar-2014 09-Apr-2014 20-May-2014 31-Jul-2021 3.68 3.35 0

TF-16640 09-Apr-2014 09-Apr-2014 20-May-2014 31-Jul-2019 5.00 5.00 0

Policy Waiver(s)

Does this restructuring trigger the need for any policy waiver(s)?No

I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING

A. Current Project description

1. The Project development objective (PDO) is to increase the utilization of community nutrition and primary maternal and child health services in selected regions in the Recipient’s territory.

The six PDO-level results indicators are:(a) Percentage of children 0-6 months exclusively breastfed (b) Number of births (deliveries) attended by skilled health personnel (c) Percentage of children 6-23 months consuming at least four out of six food groups (d) Number of women using modern methods of family planning (e) Number of direct project beneficiaries (f) Percentage of female beneficiaries

The Project has five components: Component 1: Community Mobilization for Social and Behavior Change 2. This component supports: (i) Results based financing (RBF) contracts through conditional cash transfers (CCTs) with communities and Village Support Groups (VSGs) to increase demand for and utilization of health and nutrition services through counseling and timely referrals for life-saving health services (e.g., hygiene, sanitation, counseling on infant and young child feeding, delayed first pregnancy and child spacing, referral of pregnant women and children with danger signs to health centers) and improved food and nutrition security; (ii) CCTs to individual women to increase utilization of antenatal care (ANC) in the first trimester; and (iii) Social and behavior change communication (SBCC) including messaging on vulnerabilities and unconditional cash transfers, adolescent health and nutrition, early childhood care and early stimulation as well as increased implementation intensity.

Component 2: Delivery of Community Nutrition and Primary Health Care Services 3. This Component supports the delivery of nutrition and primary health care services as well as local food and nutrition security through (i) Performance-based financing (PBF) grants to health centers for the delivery of a predefined package of maternal and child health and nutrition services at primary and referral health care facilities (37 facilities in five health regions); (ii) startup support for effective service delivery, including the implementation of selected health care waste management measures; (iii) health system strengthening for infectious disease preparedness and control (specifically for strengthening the data management and reporting system); (iv) Primary Health Care (PHC) scale-up in support of the Ministry of Health (MOH) strategy; (v) Scaling-up food security-enhanced Baby-Friendly Community


Initiative (BFCI) across all five health regions, and the pregnant women and women with children under five living in the most vulnerable households are identified using a combination of geographical, categorical and community targeting approaches; (vi) Unconditional Cash Transfers (UCTs) to households that receive Food and Nutrition Security (FNS) inputs; and (vii) addressing bottlenecks in quality of care such as to improve supply chain management and procure a short-term supply of essential medicines, to develop and disseminate guidelines for the management of acute malnutrition as part of the Integrated Management of Acute Malnutrition (IMAM), and to support improvements in quality of reproductive healthcare provision (e.g. quality of family planning counseling, antenatal care provision, skilled delivery), including in-service clinical training on these services.

Component 3: Capacity Building for Service Delivery, Results-Based Management, Food and Nutrition Security and Cash Transfers 4. This component supports i) Capacity building for service delivery and RBF at both community and facility levels; ii) Monitoring and Evaluation (M&E), operational research and verification; iii) Coordination and program management at all levels; and iv) performance contracts with the National Nutrition Agency (NaNA), MOH RBF Committee, Regional Health Directorates (RHDs), Department of Community Development (DCD), and Regional Task Forces (RTFs),

Component 4: Ebola Virus Disease Preparedness and Control 5. The component supported social mobilization (e.g. development and distribution of communication materials) and case management (e.g. health care worker training and preparedness, provision of personal protective equipment) through a Memorandum of Understanding (MoU) with the World Health Organization (WHO) for technical assistance from February 5, 2015 to June 30, 2016.

Component 5: Contingent Emergency Response 6. This is to allow for rapid reallocation of project proceeds in the event of a natural or man-made disaster or crisis that has caused, or is likely to imminently cause, a major adverse economic and/or social impact.

B. Project Status

7. The PDO remains relevant in the context of the current MOH and NaNA priorities and thus does not require revision.

Achievements 8. Health service utilization has improved. The implementation of the RBF activities has been successful and led to a greater uptake in health service utilization. The PDO-level indicators have shown improvement. For instance, the 69 percent of children 0-6 months who are exclusively breastfed has surpassed the July 2021 target of 60 percent. Similarly, 94,735 deliveries were attended by skilled health personnel which is close to the July 2021 target of 96,000. Nevertheless, the 22 percent of children age 6-23 months consuming at least four out of seven food groups (in the 2018 MICS 5 out of 8 food groups was reported) is far less than the July 2021 target of 35 percent. Regarding the intermediate results indicators in the results framework, most of the endline July 2021 targets have either been achieved or are on track to be achieved by December 2019. For instance, as of December 31, 2018, 47,731 pregnant women received their first antenatal care in the first trimester which is close to half the July 2021 target of 96,000 Further, 315,295 children aged 12-59 months received deworming tablets which is more than twice the endline target of 143,500.

9. Quality of Care has improved. The project has contributed to achieving a tremendous improvement in quality of care (QoC) in the 37 project-supported health facilities. The first revision of the QoC checklist was undertaken in 2016, and it has been in use since the first quarter of 2017. During September-December 2018, a World Bank (WB) consultant


worked closely with a QoC technical working group (TWG), which comprised of representatives from the PIC and the MOH Quality Assurance Unit, to analyse the QoC scores and undertake site visits to feed into the revision of the QoC checklist. The median QoC score in the 37 project-supported health facilities increased from 71.7 percent in the first quarter of 2017 to 86.1 percent in the second quarter of 2018. Nevertheless, in-depth analysis of the data for the second quarter of 2018 revealed that the health facilities were performing well on some indicators (such as monitoring in the early post-partum period for early identification of danger signs, protocols for the management of obstetric complications, and management of business plans) but less so on other indicators (such as financial management and procurement processes). In December 2018, the TWG produced a revised comprehensive QoC checklist for minor health centers, major health centers and hospitals, along with a pocket guide for its administration, following a 2-day workshop for MOH staff at national and regional levels in September 2018 and pretesting in October 2018.1 Additionally, a new checklist was developed for Reproductive and Child Health (RCH) clinics that do not provide all the services of a health centre. A Training of Trainers Worksop was conducted during October 29-November 2, 2018 for all 7 Regional Health Directorates in The Gambia. In 2019, the QoC checklist will also be employed for supportive supervision in the two non-project regions beginning in the first quarter of 2019; the TWG plans to create an electronic format of the checklist, to use tablets for administering it, and for direct capture of the data in the DHIS2.

10. RBF Sustainability Roadmap under implementation. The MOH, Ministry of Finance and Economic Affairs (MOFEA), and NaNA jointly developed an RBF Sustainability Roadmap in September 2018 which proposed a National RBF institutional framework with details on institutional sustainability, financial sustainability, and operational sustainability. The implementation of the Roadmap is underway: a) the MOH in consultation with development partners, including Global Fund, Gavi and UNICEF, is revamping the existing Project Coordination Unit (PCU) to assume the role of fund holding and payment of invoices as well as to manage other donor-funded activities; b) an RBF Unit is being established to perform RBF purchasing and management functions; c) MOH national steering committee is being formed to oversee the PCU and the RBF unit; d) NaNA will play a future role of a Contract Development and Verification Agent; and e) a Health Financing Strategy with an eye towards Universal Health Coverage and incorporating RBF as one of the strategic interventions and reforms, is being finalized. Since January 2019, as part of the transition from operating in a Project mode to a national RBF program which is fully integrated in the health sector, the current Project RBF Focal Point is working closely with the PIC and MOH to develop the national RBF operational framework, and to help build capacity of the MOH. Regarding financial sustainability, the MOH and MOFEA have demonstrated commitment to RBF by allocating GMD 12,000,000 (about US$250,000) of the 2019 Government budget to RBF, but this will only cater to 2 more months of payment to health facilities. The January 2019 mission advised that the 2020 Government budget allocation to RBF should be increased. The mission informed that the WB is currently preparing a Systematic Country Diagnostic which will feed into the upcoming Country Partnership Framework (CPF) and that will be an avenue to dialogue with the WB Country Management Unit during the consultative process for future WB support. The mission advised the PIC to prepare a comprehensive Project progress report (from Project effectiveness to December 2018) including lessons learned and recommendations. This will feed into the CPF as well as inform the implementation completion report at project closing.

Main challenge 11. Health Care Waste Management Plan. As stated in the project appraisal document, the project triggered the Environmental Assessment Policy OP4.01 for health care waste generation, which required the need for proper management and disposal in the 37 project-supported health facilities. The Health Care Waste Management Plan (HCWMP) was developed and disclosed in January 2014. The HCWMP was designed with the following six objectives: (a)

1 Eight indicators for which health facilities scored over 90 percent were dropped from the previous list. It is likely the QoC scores in the first quarter of 2019 will reduce when the revised checklist is first administered, as was the case in the first quarter of 2017 following the 2016 revisions. At project completion, the indicators that have been dropped should be measured so a more accurate improvement in QoC is captured.


reinforce the national legal framework for Health Care Waste Management (HCWM); (b) improve the institutional framework for HCWM; (c) assess the HCWM situation, propose options for health care facilities and improve the HCWM in the health care facilities; (d) conduct awareness campaigns for the communities and provide training for all actors involved in HCWM; (e) support private initiatives and partnership in HCWM; and (f) develop and operationalize specific financial resources to cover the costs of the management of health care wastes. A WB Safeguards mission during January 9-11, 2019 assessed the progress of the implementation of the HCWMP. The mission noted that MOH developed a comprehensive draft HCWM policy in 2015, but it was yet to be adopted as required for objective (a) above. Additionally, objectives (c) and (d) were partially implemented but the rest were seriously lagging. Of the 37 incinerators that were to be constructed, only 5 have been completed. Moreover, there has been no HCWMP implementation status report since project effectiveness and the January-February 2018 midterm review report did not highlight HCWMP issues. The recommended actions have been budgeted for and included in the activities for the January-December 2019 annual work program and a progress update will be provided quarterly.

C. Rationale for Restructuring

12. Due to the high utilization of services, the financing for the RBF incentive payments to health facilities has been exhausted, well ahead of the July 2021 Project closing date. Thus, reallocation of funds across disbursement categories will allow the activities of all Project components to be carried out until December 2019. However, data verification of the services provided by the health facilities in the last quarter of 2019 and related activities will be carried out in early 2020. A project closing date of June 30, 2020 is proposed but this will be revisited in the last quarter of 2019 depending on Project disbursement. Additionally, the PDO-level baseline values have been recomputed since the original values pertained to all 7 regions instead of the 5 project regions, endline targets have been adjusted, and some indicators have been revised or definitions clarified. Thus, the proposed Project restructuring will entail: a) reallocation between disbursement categories; b) revising the closing date; and c) revising the results framework. The MOFEA submitted a restructuring request letter to the WB on January 24, 2019. However, there was delay in the release of the findings of the 2018 Multiple Indicator Cluster Survey (MICS), which was needed to set a realistic endline targets for the PDO level indicators.

II. DESCRIPTION OF PROPOSED CHANGES

13. The proposed changes are:

(a) adjustment of the closing date from July 21, 2021 to June 30, 2020(b) reallocation between disbursement categories. The details are in section IV(c) revising the results framework. The proposed changes for each indicator are described in Table 1. Some of the changes include clarifying the indicator formulation and definition, revising baseline and endline values, revising two of the PDO-level indicators from outputs to outcomes, introducing the new corporate results indicators, and including data sources for PDO-level indicators. Given the progress made so far, the July 2021 endline targets for most of the intermediate results indicators were maintained. The updated results framework with updated progress values is in the last section.

Table 1. Summary of Changes to the Results Framework

Indicator CommentsPDO-level indicators


Indicator CommentsChildren 0-6 months exclusively breastfed (percentage)REVISED

Baseline value recomputed for the five project intervention regions, and original endline target of 60% for July 2021 was not changed since the 2018 MICS value is 69% (2013 Demographic and Health Survey (DHS) as the baseline, midline impact evaluation for 2016, MICS for 2018 and DHS for 2019).

Births (deliveries) attended by skilled health personnel (number)REVISEDDeliveries in health facilities (percentage) NEW

This indicator is considered output and was moved to intermediate results indicators section. The new PDO indicator is an outcome indicator with a new target. The baseline value has been computed for the five project intervention regions (2013 DHS as the baseline, midline impact evaluation for 2016, MICS for 2018 and DHS for 2019).

Children age 6-23 months consuming at least four out of six food groups (percentage)REVISED Children age 6-23 months consuming at least four out of seven food groups (percentage)

The 6 types of food groups have been changed to 7 per DHS standard and the food groups have been specified. The baseline value has been recomputed for the five project intervention regions, and the original endline target of 35% for July 2021 has been revised to 20% for December 2019 since the 2016 value was 15.7% - the 2018 MICS measured 5 our of 8 food groups (2013 DHS as the baseline, midline impact evaluation for 2016, MICS for 2018 and DHS for 2019).

Women using modern methods of family planning (number)REVISEDWomen using modern contraceptives (percentage)NEW

This indicator is considered output and was moved to the intermediate results indicators section. The new PDO indicator is an outcome indicator with a new target. The baseline value has been computed for the five project intervention regions and the endline target has been revised (2013 DHS as the baseline, midline impact evaluation for 2016, MICS for 2018 and DSH for 2019).

Direct project beneficiariesDROPPED

No longer a corporate results indicator

Female beneficiariesDROPPED

No longer a corporate results indicator

Intermediate results indicatorsDeliveries attended by skilled health personnel (number)REVISED

New corporate results indicatorPrevious PDO indicator – births (deliveries) attended by skilled health personnel (number)

New acceptors of modern contraception (number)REVISED

Previous PDO indicator - Women using modern methods of family planning (number)

People who have received essential health, nutrition and population (HNP) services (number)NEW

New corporate results indicatorThe indicator measures the sum of the number of children immunized, the number of women and children who have received basic nutrition services, and the number of deliveries attended by skilled health personnel, through operations


Indicator Commentssupported by the World Bank. In the case of this project, “nutrition services” and “deliveries attended by skilled health personnel” are captured.

Pregnant women referred by village health workers and community birth companions for delivery and complication managementREVISED

VSG members changed to village health worker and community birth companions

Hand washing stations/points establishedNO CHANGE

Community registers updated quarterlyNO CHANGE

A community health nurse is responsible for providing data.

Pregnant/lactating women, adolescent girls and/or children under age five-reached by basic nutrition services (number)REVISEDWomen and children who have received basic nutrition services (number)

Definition has been changed to conform to the new corporate results indicator.

Children between the age of 6 and 59 months receiving Vitamin A supplementation (number)NO CHANGE

Cumulative numbers reported

Pregnant women receiving iron and folic acid (IFA) supplements (number)NO CHANGE


Children under the age of 24 months benefiting from improved infant and young child feeding (IYCF) practices (number)DROPPED

Difficulty in collecting the data

Children under age five treated for moderate or severe acute malnutrition (number)NO CHANGECommunities implementing BFCI activities (number)REVISED

Target revised from 1,100 to 950

Children age 12-59 months dewormed (number)REVISED

Omitted in the preceding year

Pregnant women coming for antenatal care in the first trimester (number)REVISED


Post-partum mothers supplemented with VAS (number)REVISED



Indicator CommentsVulnerable households supported in participating in gardening or keeping ruminants or poultry in intervention areasREVISEDHouseholds supported with Food and Nutrition Security (FNS) inputs (small ruminants, poultry and back yard garden and labor serving devices)NEW

Project administrative data

Communities supported in establishing child food banksREVISED

Endline target revised from 250 to 90Data will be collected October to December each calendar year

Health workers (including central and regional level managers) trained on RBF managementNO CHANGERBF adopted in the revised health financing policyNO CHANGEHealth personnel receiving trainingNO CHANGEHealth personnel trained on Ebola prevention and managementNO CHANGEHealth facilities receiving Client Tracer and Satisfaction Survey Feedback at least 3 times during the Calendar yearNO CHANGEHealth facilities scoring at least 75% on the Quality ChecklistREVISED

Endline target revised from 100% to 85%.The original quality of care checklist was focused mainly on structural measures which are relatively easy to improve. However, as health facilities scored high on the structural measures, the checklist were revised in 2016 and 2018 in order to place emphasis on process and outcome measures. Quality of care scores tend to reduce initially following such revisions.

Selected recipients who meet the targeting criteriaNO CHANGESelected recipients who receiveall cash transfers according tothe payment planDROPPED

Difficult to measure

Recipients of UCTNO CHANGE

Endline target revised from 5,000 to 2,300.


III. SUMMARY OF CHANGES

Changed Not Changed

Results Framework ✔

Components and Cost ✔

Loan Closing Date(s) ✔

Reallocation between Disbursement Categories ✔

Disbursement Estimates ✔

Implementation Schedule ✔

Implementing Agency ✔

DDO Status ✔

Project's Development Objectives ✔

Cancellations Proposed ✔

Disbursements Arrangements ✔

Overall Risk Rating ✔

Safeguard Policies Triggered ✔

EA category ✔

Legal Covenants ✔

Institutional Arrangements ✔

Financial Management ✔

Procurement ✔

Other Change(s) ✔

Economic and Financial Analysis ✔

Technical Analysis ✔

Social Analysis ✔

Environmental Analysis ✔

IV. DETAILED CHANGE(S)


OPS_DETAILEDCHANGES_COMPONENTS_TABLE

COMPONENTS

Current Component Name

Current Cost

(US$M)Action Proposed

Component NameProposed

Cost (US$M)

Community mobilization for social and behavior change 5.15 Revised Community mobilization for

social and behavior change 4.31

Delivery of community nutrition and primary health care services 11.53 Revised

Delivery of community nutrition and primary health care services

12.37

Capacity building for service delivery, results-based financing, food and nutrition security and cash transfers

4.00 Revised

Capacity building for service delivery, results-based financing, food and nutrition security and cash transfers

4.00

Ebola preparedness and control 0.50 No Change Ebola preparedness and control 0.50

Contingent Emergency Response 0.00 No Change Contingent Emergency Response 0.00

TOTAL 21.18 21.18

OPS_DETAILEDCHANGES_LOANCLOSING_TABLE

LOAN CLOSING DATE(S)

Ln/Cr/Tf StatusOriginal Closing

Revised Closing(s)

Proposed Closing

Proposed Deadline for Withdrawal

Applications

IDA-56230 Effective 31-Jul-2019 31-Jul-2021 30-Jun-2020 30-Oct-2020

IDA-59420 Effective 31-Jul-2021 30-Jun-2020 30-Oct-2020

IDA-D0500 Effective 31-Jul-2019 31-Jul-2021 30-Jun-2020 30-Oct-2020

IDA-D1600 Effective 31-Jul-2021 30-Jun-2020 30-Oct-2020

IDA-H9230 Effective 31-Jul-2019 31-Jul-2021 30-Jun-2020 30-Oct-2020

TF-16640 Effective 31-Jul-2019

OPS_DETAILEDCHANGES_REALLOCATION _TABLE

REALLOCATION BETWEEN DISBURSEMENT CATEGORIES

Current Allocation Actuals + Committed Proposed Allocation Financing %(Type Total)

Current Proposed

IDA-56230-001 | Currency: XDR


iLap Category Sequence No: 1 Current Expenditure Category: Cond Cash transf A1,A2

516,500.00 161,440.67 432,200.00 100.00 100.00

iLap Category Sequence No: 1A Current Expenditure Category: Cond Cash transf A1,A2 NBRW,CRR,URR

0.00 0.00 0.00 100.00 100.00

iLap Category Sequence No: 1B Current Expenditure Category: Cond Cash transf A1,A2,NBR-E,LRR

0.00 0.00 0.00 100.00 100.00

iLap Category Sequence No: 2 Current Expenditure Category: PBF GRANTS under Pt B1

488,200.00 254,824.19 572,200.00 100.00 100.00

iLap Category Sequence No: 2A Current Expenditure Category: PBF B1,NBR-W,CRR,URR

0.00 0.00 0.00 100.00 100.00

iLap Category Sequence No: 2B Current Expenditure Category: PBF,B1,NBR-E,LRR

0.00 0.00 0.00 100.00 100.00

iLap Category Sequence No: 3 Current Expenditure Category: GD,WK,NCS,CS,TR,OC, Pt A3,B2

707,300.00 707,511.05 707,600.00 100.00 100.00

iLap Category Sequence No: 3A Current Expenditure Category: GD,WK,NCS,CS,TG,OC, B2 NBRW,CRR,URR

0.00 0.00 0.00 100.00 100.00

iLap Category Sequence No: 3B Current Expenditure Category: GD,WK,NCS,CS,TG,OC, B2 NBR-E,LRR

0.00 0.00 0.00 100.00 100.00

iLap Category Sequence No: 4 Current Expenditure Category: GD,WK,NCS,CS,TG,OC, A3 AND C

0.00 0.00 0.00 100.00 100.00


iLap Category Sequence No: 5 Current Expenditure Category: GD,WK,NCS,CS,TG,OC,PART B3

88,000.00 0.00 88,000.00 100.00 100.00

iLap Category Sequence No: 7 Current Expenditure Category: Emerg Exp under PT E

0.00 0.00 0.00 100.00 100.00

Total 1,800,000.00 1,123,775.91 1,800,000.00

IDA-59420-001 | Currency: XDR

iLap Category Sequence No: 3 Current Expenditure Category: GDS,WK,NCS,CS,TRG OP prt A.3,B.2,C

1,700,000.00 0.00 1,950,000.00 100.00 100.00

iLap Category Sequence No: 6 Current Expenditure Category: Unconditional Cash Transfer part B4

700,000.00 0.00 200,000.00 100.00 100.00

iLap Category Sequence No: 7 Current Expenditure Category: Emerg Expenses part E

0.00 0.00 0.00 100.00 100.00

iLap Category Sequence No: 2 Current Expenditure Category: PBF Grants under Part B1

0.00 0.00 250,000.00 100

Total 2,400,000.00 0.00 2,400,000.00

IDA-D1600-001 | Currency: XDR

iLap Category Sequence No: 3 Current Expenditure Category: GDS,WK,NCS,CS,TRG OP prt A.3,B.2,C

2,300,000.00 1,613,881.43 2,553,600.00 100.00 100.00

iLap Category Sequence No: 6 Current Expenditure Category: Unconditional Cash Transfer part B.


900,000.00 143,447.97 286,200.00 100.00 100.00

iLap Category Sequence No: 7 Current Expenditure Category: Emerg Expenses part E

0.00 0.00 0.00 100.00 100.00

iLap Category Sequence No: 2 Current Expenditure Category: PBF Grants under Part B1

0.00 0.00 360,200.00 100

Total 3,200,000.00 1,757,329.40 3,200,000.00

OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE

DISBURSEMENT ESTIMATES

Change in Disbursement EstimatesYes

Year Current Proposed

2014 0.00 0.00

2015 1,020,797.08 0.00

2016 997,493.68 0.00

2017 2,026,465.57 0.00

2018 4,559,531.26 0.00

2019 2,400,000.00 0.00

2020 2,400,000.00 0.00

2021 2,400,000.00 0.00

2022 375,712.41 0.00

2023 0.00 0.00

.


.Results framework

COUNTRY: Gambia, TheMaternal and Child Nutrition and Health Results Project

Project Development Objectives(s)

A. Proposed Development Objective

The development objective of the project is to increase the utilization of communitynutritionand primary maternal and child health services in selected regions in the Recipient’s territory.

Project Development Objective Indicators by Objectives/ OutcomesRESULT_FRAME_TBL_PDO

Indicator Name DLI Baseline Intermediate Targets End Target

1 2

Increased utilization of community nutrition

Children 0-6 months exclusively breastfed (Percentage) 47.00 48.00 54.00 60.00

Action: This indicator has been Revised

Rationale:

Baseline value recomputed for the five project intervention regions, and original endline target of 60% for July 2021 was maintained for December 2019

Children age 6-23 months consuming at least four out of seven food groups (Percentage)

7.60 15.00 16.00 20.00


Rationale:

The 6 types of food groups have been changed to 7 per DHS standard and the food groups have been specified.

Baseline value recomputed for the five project intervention regions, and original endline target of 35% for July 2021 revised to 20% for December 2019 since the 2016 value was 15.7.

The current value of 22.2 form the MICS is based on 5 out of 8 food groups instead of the 4 out of 7 food groups in the DHS.


RESULT_FRAME_TBL_PDO


1 2

Increased utilization of primary maternal and child health services

Deliveries in health facilities (Percentage) 43.00 55.00 58.00 60.00


Rationale:

The previous indicator is considered output and was moved to intermediate results indicators section. The new PDO indicator is an outcome indicator with a new target based on the baseline value.

Baseline value computed for the five project intervention regions

Women using modern contraceptives (Percentage) 3.50 7.00 15.00 15.00


Rationale:

The previous indicator is considered output and was moved to intermediate results indicators section. The new PDO indicator is an outcome indicator with a new target.

Baseline value computed for the five project intervention regions and endline target revised

Direct project beneficiaries (Number) 0.00 1,400,000.00

Action: This indicator has been Marked for Deletion

Female beneficiaries (Percentage) 70.00 70.00


People who have received essential health, nutrition, and population (HNP) services (CRI, Number)

98,885.00 500,000.00




1 2


Number of women and children who have received basic nutrition services (CRI, Number)

90,000.00 593,000.00


Children between age 6 and 59 months receiving Vitamin A supplementation (Number)

70,000.00 475,000.00


Pregnant women receiving iron and folic acid (IFA) supplements (Number) 9,000.00 18,000.00


Children under age 24 months benefiting from improved infant and young child feeding (IYCF) practices (Number)

10,000.00 95,000.00


Children under age 5 years treated for moderate or severe acute malnutrition (Number)

200.00 5,000.00




1 2


Number of deliveries attended by skilled health personnel (CRI, Number) 0.00 23,000.00


Children 12-59 dewormed in the preceding year (Number) 6,461.00 143,500.00


Post-partum mothers supplemented with VAS in the preceding year (Number)

22,200.00 138,900.00


PDO Table SPACE

Intermediate Results Indicators by ComponentsRESULT_FRAME_TBL_IO


1 2 3 4

Component 1: Community Mobilization for Social and Behavior Change (Action: This Component has been Revised)

Pregnant women referred by village health workers and community birth companions

0.00 1,000.00 4,000.00 9,000.00 16,500.00 28,500.00


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for delivery and complication management (Number)


Rationale:


Hand washing stations/points established (Number) 0.00 0.00 250.00 1,500.00 4,000.00 10,000.00


Rationale:


Component 2: Delivery of Community Nutrition and Primary Health Care Services

People who have received essential health, nutrition, and population (HNP) services (CRI, Number)

0.00 13,834.00 119,334.00 238,834.00 375,834.00

Action: This indicator is New

Rationale:

New corporate results indicator

The indicator measures the sum of the number of children immunized, the number of women and children who have received basic nutrition services, and the number of deliveries attended by skilled health personnel, through operations supported by the World Bank. In the case of this project, “nutrition services” and “deliveries attended by skilled health personnel” are captured.

People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (CRI, Number)

50.00 50.00


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Number of women and children who have received basic nutrition services (CRI, Number)

0.00 4,719.00 95,219.00 195,719.00 311,719.00 904,719.00


Rationale:

Definition has been changed to conform to the new corporate results indicator.

Number of deliveries attended by skilled health personnel (CRI, Number)

0.00 9,115.00 24,115.00 43,115.00 64,115.00 87,115.00


Rationale:

New corporate results indicator

Previous PDO indicator – births (deliveries) attended by skilled health personnel (number)

New acceptors of modern contraception (Number) 12,925.00 26,000.00 40,000.00 54,000.00 70,000.00 90,000.00

Action: This indicator is New Rationale:

Previous PDO indicator - Women using modern methods of family planning (number)

Pregnant/lactating women, adolescent girls and/or children under age five-reached by basic nutrition services (number) (Number)

90,000.00 593,000.00


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Rationale:

This is no longer a corporate results indicator. It has been replaced by Women and children who have received basic nutrition services (number). It is being kept in the results framework because when it is deleted the data on the sub-indicators will be deleted as well.

Children between the age of 6 and 59 months receiving Vitamin A supplementation (number) (Number)

70,000.00 70,000.00

Pregnant women receiving iron and folic acid (IFA) supplements (number) (Number)

9,000.00 18,000.00 39,000.00

Children under age five treated for moderate or severe acute malnutrition (number) (Number)

200.00 400.00

Children between the age of 6 and 59 months receiving Vitamin A supplementation (number) (Number)

70,000.00 70,000.00

Pregnant women receiving iron and folic acid (IFA) supplements (number) (Number)

9,000.00 18,000.00 39,000.00

Children under the age of 24 months benefiting from improved infant and young

10,000.00 95,000.00


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child feeding (IYCF) practices (number) (Number)

Children under age five treated for moderate or severe acute malnutrition (number) (Number)

200.00 400.00

Post-partum mothers supplemented with VAS in the preceding year (cumulative) (Number)

22,200.00 44,400.00 66,900.00 89,900.00 119,000.00 145,000.00

Pregnant women coming for ANC in the first trimester (cumulative) (Number)

2,342.00 4,700.00 7,200.00 10,200.00 14,000.00 26,000.00

Children age 12-59 months dewormed (Number) 6,461.00 17,500.00 32,500.00 57,500.00 97,500.00 143,500.00

Households supported with Food and Nutrition Security (FNS) inputs (small ruminants, poultry and back yard garden and labor serving devices. (Number)

0.00 0.00 0.00 0.00 900.00 1,500.00

Communities supported in establishing child food banks (Number)

0.00 0.00 0.00 0.00 50.00 90.00

Communities implementing BFCI activities (Number) 633.00 950.00

Selected recipients who receive all cash transfers 0.00 80.00


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according to the payment plan (Percentage)

Selected recipients who meet the targeting criteria (Percentage)

0.00 80.00

Recipients of UCT (Number) 0.00 0.00 0.00 0.00 900.00 2,300.00

Community registers updated quarterly (Number) 341.00 341.00 700.00 1,100.00 1,550.00 2,110.00

Component 3: Capacity Building for Service Delivery, Results-Based Management, Food and Nutrition Se (Action: This Component has been Revised)

RBF adopted in the revised health financing policy (Yes/No)

No Yes Yes


Health facilities receiving Client Tracer and Satisfaction Survey Feedback at least 3 times during the Calendar year (Percentage)

0.00 0.00 0.00 70.00 70.00 70.00


Health facilities scoring at least 75% on the Quality Checklist (Percentage)

0.00 0.00 0.00 85.00 85.00 85.00


Rationale:

Endline target revised from 100% to 85%.


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The original quality of care checklist was focused mainly on structural measures which are relatively easy to improve. However, as health facilities scored high on the structural measures, the checklist were revised in 2016 and 2018 in order to place emphasis on process and outcome measures. Quality of care scores tend to reduce initially following such revisions.

Health personnel receiving training (number) (Number) 0.00 15.00 90.00 245.00 515.00 1,715.00


Rationale:


Health workers (including central and regional level managers) trained on RBF management (Number)

38.00 90.00 170.00 270.00 410.00 610.00


Rationale:

Cumulative numbers

Component 4: Ebola Virus Disease Preparedness and Control (Action: This Component has been Revised)

Health personnel trained on Ebola prevention and management (Number)

0.00 100.00


Rationale:

cumulative numbers reported

Component 5: Contingent Emergency Response (Action: This Component has been Revised)

No indicator required (Text) None None


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IO Table SPACE


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