RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF THE COMMUNITY NUTRITION PROJECT GRANT (TF095274) August 27, 2009 TO THE

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1 Public isclosure Authorized Public isclosure Authorized Public isclosure Authorized Public isclosure Authorized ocument of The World Bank RESTRUCTURING PAPER ON A PROPOSE PROJECT RESTRUCTURING OF THE COMMUNITY NUTRITION PROJECT GRANT (TF095274) August 27, 2009 TO THE LAO PEOPLE S EMOCRATIC REPUBLIC July 18, 2012 Report No: LA

2 ABBREVIATIONS AN ACRONYMS CB CBN CCT CNP HC ISR MOH PO WB Community Based istributor Community Based Nutrition Conditional Cash Transfer Community Nutrition Project Health Center Implementation Status Report Ministry of Health Project evelopment Objective World Bank Regional Vice President: Country irector: Sector Manager / irector: Task Team Leader: Pamela Cox Annette ixon Toomas Palu Ajay Tandon

3 LAO PEOPLE'S EMOCRATIC REPUBLIC COMMUNITY NUTRITION PROJECT CONTENTS Page A. SUMMARY... 1 B. PROJECT STATUS... 1 C. PROPOSE CHANGES... 2 ANNEX 1: RESULTS FRAMEWORK AN MONITORING... 4 ANNEX 2: ALLOCATION OF PROCEES... 8 P i

4 Lao People's emocratic Republic Community Nutrition Project GRANT (TF095274) Restructuring Restructuring Type: Level Two ata Sheet 1. Basic Information Project Id & Name P114863: FPCR TF For Lao PR On Nutrition: CNP Country Lao People's emocratic Republic Task Team Leader Ajay Tandon Sector Manager/irector Toomas Palu Country irector Annette ixon Original Board Approval ate 08/27/2009 Original Closing ate: 09/30/2012 Current Closing ate 09/30/2012 Proposed Closing ate [If Applicable] 09/30/2013 EA Category C-Not Required Revised EA Category C-Not Required-Not Required EA Completion ate Revised EA Completion ate 2. Revised Financing Plan (US$M) Source Original Revised BORR SPF Total Borrower Organization epartment Location Ministry Of Finance Lao People's emocratic Republic 4. Implementing Agency Organization epartment Location Ministry Of Health Lao People's emocratic Republic 5. isbursement Estimates (US$M) Actual Amount isbursed As Of 06/03/ Fiscal Year Annual Cumulative Total 2.00 ii

5 6. Policy Exceptions And Safeguard Policies oes the restructured project require any exceptions to bank policies? oes the restructured project trigger any new safeguard policies? If yes, please select from the checklist below and update ISS accordingly before submitting the package. N N 7a. Project evelopment Objectives/Outcomes Original/Current Project evelopment Objectives/Outcomes To improve coverage of essential maternal and child health services and improve mother and child caring practices among pregnant and lactating women and children less than 2 years old in the seven southern and central provinces. 7b. Revised Project evelopment Objectives/Outcomes [If Applicable] iii

6 COMMUNITY NUTRITION PROJECT RESTRUCTURING PAPER A. SUMMARY 1. The Community Nutrition Project (TF095274) is being amended to revise and simplify the Project s results framework, to extend the closing date from September 30, 2012 to September 30, 2013, and to reallocate Grant proceeds to continue support for supply-side activities. B. PROJECT STATUS 2. The Community Nutrition Project (CNP) was prepared under World Bank (WB) emergency procedures and was supported by two sources of financing: (a) the Food Price Crisis Response Trust Fund (TF095274) of US$2 million with a closing date of 30 September, 2012; and (b) the European Union Food Crisis Rapid Response Facility Trust Fund (TF097071) of US$2.12 million equivalent which closed on February 29, The Project evelopment Objective (PO) is to improve coverage of essential maternal and child health services and improve mother and child caring practices among pregnant and lactating women and children less than two years old in the seven southern and central provinces. The PO remains relevant and unchanged. 4. The project s implementation status and the progress towards achieving the PO were both rated as Moderately Satisfactory in the November 2011 Implementation Status Report (ISR), reflecting significant improvements since the previous ISR and the likelihood that the development objectives will be met. The current disbursement rate is US$564, (equivalent to 28%) out of the total funds of US$2 million. espite initial delays resulting from low capacity and lack of familiarity with WB procedures on the part of the implementing agency, the Project has made notable progress as reflected below: Conditional Cash Transfers (CCTs): CCT enrollment events have now been held in all 62 health centers (HCs). To date, 15,962 women about 71.1% of all who were eligible in the catchment areas of the pilot HCs have enrolled in the program. Of those currently enrolled, 4,281 were pregnant women. Retroactive enrollment incentive payments and retroactive utilization payments have commenced in some HCs in Attapu and Champasak. The designated account ceiling has been increased to US$400,000 to allow for both retroactive and regular enrollment as well as utilization-based payments in all pilot HCs. CCT monitoring visits have also begun (both by the CNP team and by the internal auditing firm, ACCMIN); Community-Based Nutrition (CBN): 1,500 targeted village facilitators have received training and monthly community-level meetings have commenced. Reported attendance rates have generally been high: an average of over 40 participants per meeting among those reporting, of which an average of 34 were women. Regular 1

7 monthly supervision meetings between district and provincial Lao Women s Union (LWU) and Health Poverty Action (which is a non-governmental organization providing technical assistance for this component) representatives are being held; Supply-Side Support and Capacity Building: at least one HC staff from 59 of the 62 selected HCs have been trained in each of the five modules training program; 230 staff have been trained on supportive supervision and at least one supportive supervision visit has been conducted in all 62 HCs; 49 new Community Based istributors (CBs) have been trained to provide micronutrient and key maternal and child health messages in addition to family planning services; and 45 existing CBs have also been trained in micronutrient distribution. Ethnic Group evelopment Plan: the Plan was disclosed in three national newspapers and was also distributed to local project implementation units at both Provincial Health Office and Provincial LWU offices in the seven southern provinces in April, Consultation workshops are planned at three selected HCs during the week of July 23, C. PROPOSE CHANGES 5. Results Framework. The results framework was prepared during project design before implementation details and specific activities had been finalized and it is being restructured to harmonize with data currently being captured by instruments such as the Multiple Indicator Cluster Survey. Of the original 11 PO indicators, five are being dropped due to data unavailability or lack of relevance with CNP activities: Percentage of children 6-59 months who received vitamin A supplement during the last year; Percentage of women and children < 5 who received iron supplements in the last 6 months; Percentage of women who practice post-partum food restrictions; Percentage of children 6 23 months of age who receive foods from 4 or more food groups; and Percentage of women participating in community meetings with appropriate hand washing behavior. Other indicators are being revised in order to make them more precise and aligned with existing standardized measures so as to enhance comparability. 6. Financing. The reallocation will enable the Government of Lao to have sufficient funds for supervision and monitoring of the pilot CCT and CBN programs for the extended implementation period. 7. Closing date. A one year extension of the Grant (TF095274), from September 30, 2012 to September 30, 2013, is being sought in order to allow sufficient time to implement the CCT and CBN components, and to gain a better understanding of the feasibility and challenges faced by this pilot. This will be the first extension of the Grant s closing date. 2

8 8. Safeguards. The project has been categorized as a safeguards category C. The changes proposed in the restructuring paper do not alter the activities supported, affect the safeguards category, or trigger any new safeguards. The Project has adopted the Ethnic Group evelopment Plan to comply with the Bank s Operational Policy 4.10 on Indigenous Peoples. Related activities are being implemented satisfactorily. 3

9 Core ANNEX 1: RESULTS FRAMEWORK AN MONITORING LAO PEOPLE'S EMOCRATIC REPUBLIC: COMMUNITY NUTRITION PROJECT Project evelopment Objective (PO): To improve coverage of essential maternal and child health services, and improve mother and child caring practices among pregnant and lactating women and children less than 2 years old in the seven southern and central provinces. Revised Project evelopment Objective: PO Results: 1. Percentage of pregnant women with 2 or more antenatal care consultations with a trained health professional 2. Percentage of pregnant women who delivered in health facility 3. Percentage of children 6-59 months who received vitamin A supplement during the last year 4. Percentage of children under 1 year of age immunized with PT3 5. Percentage of children under 2 years of age who attended a well-baby consultation in the last year 6. Percentage of women and children <5 who received iron supplements in the last 6 months 7. Percentage of women who practice post-partum food restrictions 8. Percentage of infants 0-5 months of age who are fed exclusively with breast milk 9. Percentage of children 6-23 months of age who receive foods from 4 or more food groups 10. Percentage of women participating in community meetings with appropriate hand washing behavior 11. Prevalence of diarrhea in children under 5 during the previous 15 days Revised PO Result: 1. Percent of women aged years that were attended at least once during pregnancy in the past 12 months by a skilled health personnel 2. Percent of women aged with a birth in the last 12 months that delivered at a health facility 3. Percentage of children aged months receiving PT3 before their first birthday 4. Percent of women aged with a child aged 0-11 months who attended at least one routine monthly check-up in the last 12 months 5. Percent of women aged with a live birth in the past 12 month that put the newborn infant to the breast within 1 hr of birth 6. Percent of children aged 0-23 months with diarrhea in previous 2 weeks that received oral rehydration salts PO Level Results Indicators* =ropped C=Continue N= New R=Revised Unit of Measure Baseline Cumulative Target Values** YR 1 YR 2 YR 3 YR4 Frequency ata Source/ Methodology Responsibility for ata Collection Percent of women aged years that were attended at least once during pregnancy in the past 12 months by a skilled health personnel R Annually from HMIS and endline HMIS and endline MOH and WB 4

10 Percent of women aged with a birth in the last 12 months that delivered at a health facility R Annually from HMIS and endline HMIS and endline MOH and WB Percentage of children 6-59 months who received vitamin A supplement during the last year Percentage of children aged months receiving PT3 before their first birthday Percent of women aged with a child aged 0-11 months who attended at least one routine monthly check-up in the last 12 months Percentage of women and children < 5 who received iron supplements in the last 6 months Percentage of women who practice post-partum food restrictions Percent of women aged with a live birth in the past 12 months that put the newborn infant to the breast within 1 hour of birth Percentage of children 6 23 months of age who receive foods from 4 or more food groups Percentage of women participating in community meetings with appropriate hand washing behavior Percent of children aged 0-23 months with diarrhea in previous 2 weeks that received R R R R Annually from HMIS and endline Endline Endline Endline HMIS and endline Endline Endline Endline MOH and WB WB WB WB 5

11 oral rehydration salts INTERMEIATE RESULTS Intermediate Result (Component One): 1. Number of health centers that are operating the CCT program 2. Percentage of women in target areas who received at least one conditional cash payment in the last year 3. Extent of leakage to non-eligible populations 4. Percent of women who receive a CCT payment for delivery who deliver in a health facility Revised Intermediate Result (Component One): 1. Number of health centers that are operating the CCT program 2. Percentage of eligible women who have enrolled 3. Percent of enrolled pregnant women who received payment for delivery at the health facility Number of health centers that are operating the CCT program C 0 62 Percentage of eligible women who have enrolled R 0 80 Extent of leakage to noneligible populations Percent of enrolled pregnant women who received payment for delivery at the health R facility Intermediate Result (Component Two): Community Based Nutrition 1. Number of communities in which the community nutrition program is operating (facilitators have been trained and meetings are held regularly) 2. Total number of community meetings organized in target communities 3. Average number of participants in community meetings Revised Intermediate Result (Component Two): 1. Number of villages in which the 3 facilitators have been trained 2. Number of villages in which CBN meeting has been held this month 3. Average number of participants per month in CBN meetings Number of villages in which the 3 facilitators have been trained Number of villages in which CBN meeting has been held this month R R per month End of project Quarterly Quarterly End of project Quarterly HC CCT atabase HC CCT atabase HC CCT atabase CBN Training Reports CBN Village Reports HP HP HP LWU LWU 6

12 Average number of participants per month in CBN meetings R 0 15 Intermediate Result (Component Three): 1. Availability of annual report that summarizes key lessons from implementation, drawing on routine supervision and process evaluation 2. Number of Project-supported health centers in which staff have been fully trained on maternal, neonatal, and children s health course 3. Number of community-based distributors who have been trained 4. Number of household visits by community-based distributors in last quarter Revised Intermediate Result (Component Three): 1. Number of project supported health centers in which at least one staff has been trained in the 5 module training 2. Number of health centers visited by the monitoring team from central and/or provincial and/or district level every 3 months (quarterly) 3. Number of community-based distributors who have received micronutrient training Availability of annual report that summarizes key lessons from implementation, drawing on routine supervision and process evaluation Number of Project-supported health centers in which at least one staff has been trained in the R module training Number of health centers visited by the monitoring team from central and/or provincial and/or district level every 3 R 0 62 months (quarterly) Quarterly End of project Quarterly CBN Village reports Training Reports Supervision Reports LWU HP/MCHC HP/MCHC Number of community-based distributors who have received micronutrient training R 0 90 End of Project Training Reports HP/MCHC Number of household visits by community-based distributors in last quarter *Please indicate whether the indicator is a Core Sector Indicator (see further **Target values should be entered for the years data will be available, not necessarily annually 7

13 ANNEX 2: Reallocation of Proceeds Lao People's emocratic Republic: Community Nutrition Project The proposed reallocation of Grantproceeds involves the reallocation from Category (2) Consultants Services (US$38,000), and Category (3) Incremental Operation Cost managed by Lao Women s Union (US$30,000) to Category (4) Incremental Operating Cost of MOH. The table below shows the proposed revised allocation for each category of expenditure Category of Expenditure Allocation % of Financing (Inclusive of Taxes) Current Allocation (US$) Revised Allocation (US$) Current Revised 1 CCT Sub Grant 1,200,000 1,200, % 100% 2 Consultants Services 350, , % 100% 3 Incremental Operating Cost 300, , % 100% managed by Lao Women s Union 4 Incremental Operating Cost of 150, , % 100% MOH Total Amount 2,000,000 2,000,000 8