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1 Public Disclosure Authorized AFRICA Nigeria Health, Nutrition & Population Global Practice IBRD/IDA Specific Investment Loan FY 2013 Seq No: 7 ARCHIVED on 22-Dec-2015 ISR21893 Implementing Agencies: Public Disclosure Authorized Key Dates Key Project Dates Bank Approval Date:12-Jul-2012 Planned Mid Term Review Date:11-Jul-2016 Original Closing Date:31-Jul-2015 Project Development Objectives Effectiveness Date:05-Jun-2013 Actual Mid-Term Review Date:-- Revised Closing Date:31-Jul-2017 Public Disclosure Authorized Project Development Objective (from Project Appraisal Document) The development objective of the proposed Project is to assist, as part of a global polio eradication effort, the Government of Nigeria to achieve and sustain at least 80% coverage with OPV immunization in every state in the country Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured)phrpdodel To assist the Recipient, as part of a global polio eradication effort, to achieve and sustain at least 80% coverage with oral poliovaccine immunization in every state in the Recipient's territory, and sustain national routine immunization coverage. Components Public Disclosure Authorized Name Supply of oral polio vaccine to national strategic cold stores:(cost $95.00 M) Polio Eradication Operations Support:(Cost $90.00 M) Routine Immunization Support:(Cost $ M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Highly Satisfactory Overall Implementation Progress (IP) Satisfactory Highly Satisfactory Overall Risk Rating Substantial Moderate 12/22/2015 Page 1 of 10

2 Implementation Status and Key Decisions 1. Progress toward Polio Eradication: On July 24, 2015, Nigeria achieved an important milestone of interruption of wild polio virus (WPV) transmission after one year of no reported cases of WPV and no laboratory confirmed cases of WPV. There has been no WPV3 case for more than 2 years. On September 25, 2015, Nigeria was remained from the list of polio endemic countries by World Health Organization (WHO) AFRO. With this interruption of transmission, Nigeria is on the path to eradication of polio and requires two more years of no polio case detection with documentation of adequate surveillance to be certified polio free. 2. Immunization performance remains very high 98% of the 87 very high risk Local Government Areas (LGAs) achieved more than 80% of oral polio vaccine (OPV) coverage between April -October The achievement of interruption of WPV has been through the use of innovative strategies such as the creation of Polio Emergency Operation Centres, use of Inactivated poliovirus vaccine (IPV) in security challenged states such as Borno, Yobe, and Kano states and introduction of IPV into routine immunization in March Directly Observed Polio Vaccination (DOPV) to ensure that the children are actually vaccinated was implemented in LGAs where there are issues with team performance and high non-compliance, and this has resulted in reaching missed children. In addition, different demand creation activities, including ~2,700 health camps, ~1,400 polio survivor groups engagement, deployment of 10,000 of volunteer community mobilizers, assignment of over 200 religious focal persons, attractions such as community clowns, local theatres, and attractive pluses (e.g., sachet milk) were implemented in each campaign. Also, close tracking and vaccination of the missed children in internally displaced persons (IDP) camps administered 292,383 doses of OPV between weeks in Reward and sanction of the team to strengthen motivation and accountability continue to be implemented across various categories of polio workers. 3. Vaccine delivery: With UNICEF as the procurement agency, the country has been responsive to the varying OPV and routine vaccines needs. There has been no delay in OPV delivery and no stock out of routine vaccines since the beginning of this additional financing. 12/22/2015 Page 2 of 10

3 1. Progress toward Polio Eradication: On July 24, 2015, Nigeria achieved an important milestone of interruption of wild polio virus (WPV) transmission after one year of no reported cases of WPV and no laboratory confirmed cases of WPV. There has been no WPV3 case for more than 2 years. On September 25, 2015, Nigeria was remained from the list of polio endemic countries by World Health Organization (WHO) AFRO. With this interruption of transmission, Nigeria is on the path to eradication of polio and requires two more years of no polio case detection with documentation of adequate surveillance to be certified polio free. 2. Immunization performance remains very high 98% of the 87 very high risk Local Government Areas (LGAs) achieved more than 80% of oral polio vaccine (OPV) coverage between April -October The achievement of interruption of WPV has been through the use of innovative strategies such as the creation of Polio Emergency Operation Centres, use of Inactivated poliovirus vaccine (IPV) in security challenged states such as Borno, Yobe, and Kano states and introduction of IPV into routine immunization in March Directly Observed Polio Vaccination (DOPV) to ensure that the children are actually vaccinated was implemented in LGAs where there are issues with team performance and high non-compliance, and this has resulted in reaching missed children. In addition, different demand creation activities, including ~2,700 health camps, ~1,400 polio survivor groups engagement, deployment of 10,000 of volunteer community mobilizers, assignment of over 200 religious focal persons, attractions such as community clowns, local theatres, and attractive pluses (e.g., sachet milk) were implemented in each campaign. Also, close tracking and vaccination of the missed children in internally displaced persons (IDP) camps administered 292,383 doses of OPV between weeks in Reward and sanction of the team to strengthen motivation and accountability continue to be implemented across various categories of polio workers. 3. Vaccine delivery: With UNICEF as the procurement agency, the country has been responsive to the varying OPV and routine vaccines needs. There has been no delay in OPV delivery and no stock out of routine vaccines since the beginning of this additional financing. 12/22/2015 Page 3 of 10

4 1. Progress toward Polio Eradication: On July 24, 2015, Nigeria achieved an important milestone of interruption of wild polio virus (WPV) transmission after one year of no reported cases of WPV and no laboratory confirmed cases of WPV. There has been no WPV3 case for more than 2 years. On September 25, 2015, Nigeria was remained from the list of polio endemic countries by World Health Organization (WHO) AFRO. With this interruption of transmission, Nigeria is on the path to eradication of polio and requires two more years of no polio case detection with documentation of adequate surveillance to be certified polio free. 2. Immunization performance remains very high 98% of the 87 very high risk Local Government Areas (LGAs) achieved more than 80% of oral polio vaccine (OPV) coverage between April -October The achievement of interruption of WPV has been through the use of innovative strategies such as the creation of Polio Emergency Operation Centres, use of Inactivated poliovirus vaccine (IPV) in security challenged states such as Borno, Yobe, and Kano states and introduction of IPV into routine immunization in March Directly Observed Polio Vaccination (DOPV) to ensure that the children are actually vaccinated was implemented in LGAs where there are issues with team performance and high non-compliance, and this has resulted in reaching missed children. In addition, different demand creation activities, including ~2,700 health camps, ~1,400 polio survivor groups engagement, deployment of 10,000 of volunteer community mobilizers, assignment of over 200 religious focal persons, attractions such as community clowns, local theatres, and attractive pluses (e.g., sachet milk) were implemented in each campaign. Also, close tracking and vaccination of the missed children in internally displaced persons (IDP) camps administered 292,383 doses of OPV between weeks in Reward and sanction of the team to strengthen motivation and accountability continue to be implemented across various categories of polio workers. 3. Vaccine delivery: With UNICEF as the procurement agency, the country has been responsive to the varying OPV and routine vaccines needs. There has been no delay in OPV delivery and no stock out of routine vaccines since the beginning of this additional financing. 12/22/2015 Page 4 of 10

5 Immunization performance remains very high 95-98% of the 69 high risk Local Government Areas (LGAs) achieved more than 80% of oral polio vaccine (OPV) coverage between June-December Inactivated poliovirus vaccine (IPV) has been introduced in security challenged states such as Borno, Yobe, and Kano states in Directly Observed Polio Vaccination (DOPV) to ensure that the children are actually vaccinated has been implemented in LGAs where there are issues with team performance and high non-compliance, and this has resulted in reaching missed children. In addition, different demand creation activities, including ~2,700 health camps, ~1,400 polio survivor groups engagement, deployment of 10,000 of volunteer community mobilizers, assignment of over 200 religious focal persons, attractions such as community clowns, local theatres, and attractive pluses (e.g., sachet milk) are implemented in each campaign (data from December 2014 SIA). Also, close tracking and vaccination of the missed children in internally displaced persons (IDP) camps covered 57,715 children for three months. Reward and sanction of the team to strengthen motivation and accountability continue to be implemented across various categories of polio workers. Remaining issues for polio eradication continue to be: (i) performance in metro Kano; and (ii) insecurity in Borno and Yobe states. Proportion of seropositive in Metropolitan LGAs in Kano state is below threshold for 6-9 months children, and barely at threshold for 9-22 months children. The 29th ERC held on January 21-22, 2015 suggested the in-depth investigation of zero-dose children, improved validation of monitoring data, and intensive use of innovative approaches such as DOPV, health camps, and use of IPVs to address the low performance in Metro Kano urgently. In Borno state, inaccessible settlements had increased from 17% in May 2014 to 60% in December ERC recommended the continued efforts to assess vaccination coverage of specific high-risk populations (e.g., IDP) and increase permanent transit vaccination posts to cover children from inaccessible areas. 2. Vaccine delivery: With UNICEF as the procurement agency, the country has been responsive to the varying OPV needs and there have been no delays in OPV delivery since the beginning of the project. 3. Project restructuring Responding to the request for urgent funds to finance polio operations and routine immunization (RI) vaccines, the additional financing of US$200 million was approved by the World Bank s Board of Executive Directors on April 10, 2015, with the extension of the project closing date from July 2015 to July The additional financing include: (i) operational support to lead the training and planning for polio immunization plus days (IPDs) and intensified supplementary immunization activities (SIAs), provide supervision, monitoring and evaluation of all related activities, and pay allowances to vaccination personnel during IPDs and SIAs (by WHO); (ii) operational support to lead the social mobilization for the IPDs and SIAs (by UNICEF); and (iii) procurement of vaccines for RI (by UNICEF). Given their technical expertise, the AF will be implemented by WHO and UNICEF together with the National Primary Health Care Development Agency (NPHCDA), based on the agreements between the NPHCDA and WHO/UNICEF. 4. Potential Case study As described above, there are many good practices from supply-side management and accountability to demand-side incentives and community engagement generated through the polio eradication initiative that provides valuable lessons for primary health care delivery and health systems strengthening. Having a small amount of funds to develop a case study on what worked and how and implications on the other health services can greatly enhance the learning for the Bank and other institutions. 12/22/2015 Page 5 of 10

6 Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Moderate Macroeconomic -- High High Sector Strategies and Policies -- Low Low Technical Design of Project or Program -- Low Low Institutional Capacity for Implementation and Sustainability -- Moderate Low Fiduciary -- Low Low Environment and Social -- Moderate Moderate 12/22/2015 Page 6 of 10

7 Stakeholders -- Low Low Other Overall -- Substantial Moderate Results Project Development Objective Indicators Immunization coverage of OPV in the country (Percentage, Custom) Value Date 15-Apr Apr Apr Jul-2015 The source of the data is the 2015 Poilo Audit - using LQAS Immunization coverage of OPV in each high risk state (Percentage, Custom) Value Date 31-Dec Apr Oct Jul-2015 Source: 2015 Poilo Audit - using LQAS Children immunized (number) (Number, Core) Value Date 09-Jul Apr Oct Jul /22/2015 Page 7 of 10

8 Source: 2015 Poilo Audit - using LQAS Children immunized - under 12 months against DTP3 (number) (Number, Core Breakdown) Value Date 09-Jul Apr Oct Jul-2015 Direct project beneficiaries (Number, Core) Value Date 09-Jul Apr Oct Dec-2014 Source: 2015 Poilo Audit - using LQAS Female beneficiaries (Percentage, Core Supplement) Value Overall Intermediate Results Indicators 12/22/2015 Page 8 of 10

9 PHINDIRITBL PHINDIRITBL PHINDIRITBL Percentage of teams with viable vaccine according to the Vaccine Vial Monitor (Percentage, Custom) Value Date 15-Apr Apr Oct Dec-2014 Source: 2015 Poilo Audit - using LQAS Percentage of campaigns where vaccines are available on time (Percentage, Custom) Value Date 09-Jul Apr Oct Dec-2014 Pentavalent 3 coverage rate (Percentage, Custom) Value Date 05-May Feb Sep May-2017 S Overall SMART SURVEY 2015 Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed 12/22/2015 Page 9 of 10

10 P IDA Closed XDR % P IDA Effective XDR % Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P IDA Closed 12-Jul Apr Jun Jul Jul-2015 P IDA Effective 10-Apr May May Jul Jul-2017 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) P NG-Polio Eradication Support - Additional Financing,P Additional Financing NG-Polio Eradication Support Project 12/22/2015 Page 10 of 10