The World Bank Ghana - Maternal, Child Health and Nutrition Project (P145792)

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1 Public Disclosure Authorized AFRICA Ghana Health, Nutrition & Population Global Practice IBRD/IDA Investment Project Financing FY 2014 Seq No: 7 ARCHIVED on 25-Sep-2017 ISR29449 Implementing Agencies: Ministry of Health, Republic of Ghana, GHANA HEALTH SERVICES Public Disclosure Authorized Key Dates Key Project Dates Bank Approval Date:20-May-2014 Planned Mid Term Review Date:15-May-2018 Original Closing Date:30-Jun-2020 Project Development Objectives Effectiveness Date:12-Feb-2015 Actual Mid-Term Review Date:-- Revised Closing Date:30-Jun-2020 Public Disclosure Authorized Project Development Objective (from Project Appraisal Document) The project development objective is to improve utilization of community-based health and nutrition services by women of reproductive age, especially pregnant women, and children under the age of 2 years. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Component 1. Community-Based Maternal and Child Health and Nutrition Interventions:(Cost $62.00 M) Public Disclosure Authorized Component 2: Institutional strengthening Capacity Building, Monitoring and Evaluation, and Project Management:(Cost $7.50 M) Component 3: Epidemic Preparedness and Control:(Cost $3.50 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Low Low Implementation Status and Key Decisions 9/25/2017 Page 1 of 12

2 The World-Bank supported Maternal and Child Health and Nutrition Improvement Project (MCHNP) (Cr No.4563-GH) started implementation in February About 23% of project funds have been disbursed by Ghana Health Service (GHS) to the regions to enable service delivery at the Community-Based Health Planning and Services (CHPS) level. The funds released have facilitated outreach services in the communities, home visits to follow up on cases, durbars (community level meetings on health-related topics), meetings of community health committees and service delivery in over 2,400 CHPS communities. The funds have also been used to support capacity building and enhance supportive supervision of the CHPS zones by Sub District, District and Regional level officials in the country. Community-based Performance Based Financing (cpbf) has been launched in 8 pilot districts in the Upper East, Upper West, Northern and Volta Regions to test the model of financial motivation as a tool for self-directed service delivery improvement. An impact evaluation baseline has been concluded and contracts have been issued for service delivery to start. Procurement and capacity building have been initiated under the project to enhance availability of logistics and personnel. This will include the provision of vehicles, anthropometrics equipment, record books and the training of all community, Sub District, District and Regional level Health Teams. The GHS has completed the printing of about 30,000 copies of the approved National CHPS Policy and Implementation Guidelines. Given that the project is showing implementation progress and fiduciary assessments are ongoing, all safeguards and risk ratings are being retained at existing levels. For consistency, only verified annual results indicators will be reported in the ISR. The next validated figures will be reported in March /25/2017 Page 2 of 12

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5 Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Low Low Macroeconomic -- Low Low Sector Strategies and Policies -- Low Low Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Low Low Fiduciary -- Low Moderate Environment and Social -- Low Low Stakeholders -- Low Low Other Overall -- Low Low Results Project Development Objective Indicators Births (deliveries) attended by skilled health personnel (number) (Number, Custom) Value 180, , , , Date 28-Jun Dec Jun Jun /25/2017 Page 5 of 12

6 Proportion of pregnant women making the first antenatal visit before the fourth month of pregnancy. (Percentage, Custom) Value Date 28-Jun Dec Jun Jun-2020 Proportions of new females (15-49) acceptors of modern family planning methods (Percentage, Custom) Value Date 28-Jun Dec Dec Jun-2020 Proportion of children under two years in the intervention areas attending community growth promotion activities (Percentage, Custom) Value Date 28-Jun Dec Dec Jun-2020 Children 0-6 months exclusively breasted in the past 24 hours. (Percentage, Custom) Value Date 30-Dec Dec Jun Jun-2020 Direct project beneficiaries (Number, Custom) Value ,992, ,752, ,000, /25/2017 Page 6 of 12

7 Date 28-Jun Dec Jun Jun-2020 Female beneficiaries (Percentage, Custom Supplement) Value Overall Comments Intermediate Results Indicators Percentage of children aged 6-59 months having received vitamin A supplement in the last 6 months (Percentage, Custom) Value Date 30-Dec Dec Dec Jun-2020 Ambulance Stations Renovated (number) (Number, Custom) Value Date 31-Dec Jun Jun /25/2017 Page 7 of 12

8 Percentage of children aged 6-23 months who are fed from the 4+ food groups the night preceding the survey (Percentage, Custom) Value Date 30-Dec Dec Dec Jun-2020 Children under five years with diarrhea treated in the two weeks preceding the survey given ORT (Percentage, Custom) Value Date 30-Dec Dec Dec Jun-2020 Adolescents years attending health and nutrition education sessions (Number, Custom) Value , , , Date 28-Jun Dec Dec Jun-2020 Pregnant women reporting having slept under an ITN the night preceding the survey visit (Percentage, Custom) Value Date 30-Dec Dec Dec Jun /25/2017 Page 8 of 12

9 Long-lasting insecticide-treated malaria nets purchased and/or distributed (number) (Number, Custom) Value , , Health personnel receiving training (number) (Number, Custom) Value , Community counsellors trained (Number, Custom) Value , Community-based Planning and Services Zones receiving supervision visits from Sub-District level (Percentage, Custom) Value /25/2017 Page 9 of 12

10 Citizen score card rolled out in communities in 4 project districts in the Northern Region (Percentage, Custom) Value People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Value ,466, , Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Value , , Date 28-Jun Dec Jun-2020 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Value , , Overall Comments The initial data (not yet validated) from the DHIS suggest improvements in key indicators for the first six months of The number of births attended by a skilled health personnel continues to increase; the proportion of pregnant women making their first antenatal visit before the fourth month of pregnancy and the proportion of children under 2 years in the intervention areas attending community growth promotion activities have also increased. For instance, the cumulative achievement for the number of births attended by skilled attendants increased from 633,129 to 967,546 as against a project end date target of 450,000. Proportion of pregnant women making the first antenatal visit before the fourth month of 9/25/2017 Page 10 of 12

11 pregnancy seen in the first six months of the year is 45%. The annual figure for 2016 was 38% giving hope of a strong performance by the end of the year. Project direct beneficiaries have now increased to 4,752,918 over the two years of implementation approaching the project end target of 5 million using women attending antenatal services and children under 2 receiving project services. Distribution of long lasting nets is currently at 576,345 surpassing the end project target of 0.5 million. The sector is however no longer routinely collecting data on Adolescents years attending health and nutrition education sessions (Number, Custom). This has been discussed with the government and the indicator is being restored. The percentage figures in the data sheet will be updated in March 2018 when all annual figures have been validated. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P IDA Effective USD % P TF Effective USD % Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P IDA Effective 20-May Jan Feb Jun Jun-2020 P TF Effective 05-Jan Jan Feb Jun Jun-2020 Cumulative Disbursements 9/25/2017 Page 11 of 12

12 Restructuring History Level 2 Approved on 29-Jul-2015,Level 2 Approved on 30-Dec-2015 Related Project(s) There are no related projects. 9/25/2017 Page 12 of 12