Implementation Status & Results Mozambique Health Commodity Security Project (P121060)

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1 Public Disclosure Authorized Public Disclosure Authorized The World Bank Implementation Status & Results Mozambique Health Commodity Security Project (P121060) Operation Name: Health Commodity Security Project (P121060) Project Stage: Implementation Seq.No: 7 Status: ARCHIVED Archive : 09-Mar-2014 Country: Mozambique Approval FY: 2011 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key s Board Approval 30-Sep-2010 Original Closing 31-Dec-2012 Planned Mid Term Review 29-Nov-2011 Last Archived ISR Effectiveness 15-Feb-2011 Revised Closing Actual Mid Term Review 11-Dec-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objective of the proposed project is to improve the availability of selected drugs and medical supplies in Key Distribution Points in the Recipient's territory. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) losure Authorized Public Disclosure Authorized Component Name Component Cost Provision of Essential Health Commodities Strengthening Supply Chain Management 4.50 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Moderate Implementation Status Overview The Health Commodity Security Project (HCSP) was designed to assist in reducing the impact of unpredictable financing as a result of the global financial crisis of 2008 on the availability of select public health commodities. It was prepared in accordance with the Crisis Response Window (CRW) guidelines as an emergency project. It became effective on February 15, 2010, and the closing date was extended from December 31, 2012 to December 31, 2013 and now to June 30, The second and final extension for an additional six months was granted in order to give the Borrower adequate time to successfully complete all activities financed under this project. The development objective of the project is to improve the availability of selected drugs and medical supplies in key distribution points. It includes two components; The first is Page 1 of 6

2 focused on the provision of select essential health commodities which represents 89 percent of the project financing and the second on strengthening the supply chain management representing 12 percent of the project financing. The project has disbursed over 97 percent of its US$39million credit, one of the highest levels of disbursement achieved in the Mozambique Portfolio. The project has surpassed all of its project development outcome (PDO) indicator targets. Order fulfillment rates, a proxy for measuring commodity availability reached between 91 percent and 100 percent, much higher than the planned targets of 75 percent and 85 percent. The fill rate for Depo-Provera, (an injectable contraceptive and popular among women in Mozambique), was 63 percent in However, once the IDA-financed products arrived into the country in 2012, the fill rate was maintained between 91 to 100 percent for 2012 and For first-line ARVs, the fill rates for 2011 were 96%, 97% for 2012 and 100% for the first three quarters of For malaria control, the project supported the procurement of almost 2.5 million long-lasting insecticide-treated bed nets (LLINs) which have been or are planned to be distributed in five endemic provinces. In sites where the nets have been distributed, the project has achieved household coverage rates of 95 percent and above. The achievements have not come easy. The project faced multiple risks. However, the Ministry of Health (MOH) has shown proactive leadership and taken the necessary steps to address risks identified during the implementation phase, including: (i) instituting a coordinating mechanism to mitigate the risks of a fragmented supply chain; (ii) seeking technical assistance through other donors to assist in the data mining for the Results Framework; and (iii) instituting a team of people to provide daily support to the project and directly reporting to senior management. But all these efforts have taken time to address and implement, requiring the project to be extended. The project has also benefited from a sustained effort by the Ministry of Health, its direct partners in implementing the project (UNICEF, UNFPA), and the various organizations active in strengthening the supply chain in Mozambique (USAID, PEPFAR, GF, SCMS and CDC). Together, they have all contributed to a coordinated effort in the management of the supplies, moving shipments backwards and forwards in order not to overstock or under-stock the pipeline. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target ARVs ordered that are delivered to health Percentage Value facilities. The indicator is based on the most used first line ARV. Lamivudine 150mg+ Zidovudine 300mg +Nevirapine 200. Injectable contraceptives ordered that are delivered to provinces. In reviewing the data after the audit of the ERP system the final data this indicator are as follows: % (baseline) % % 2013 till Q3-100% Average over the 3 years - 98% Note: The baseline and endtarget are the same as the aim of the project was to maintain the availability over the course of the crisis period. With the extension the end target was not changed as the objective of the project was to assist in maintaining service levels. Percentage Value Nov-2010 CMAM ERP system. In reviewing the data after the audit of the ERP system the The end target and baseline are the same because the Page 2 of 6

3 Long-lasting insecticide-treated malaria nets purchased and/or distributed (number) final data this indicator are as follows: % (baseline) % % 2013 till Q3-100% Average for the 3 years - 81% aim of the project was to ensure that the availability was maintained during the years of the financial crisis. Number Value Total purchased by the project is 0 at baseline. This indicator is calculated as a cumulatively. Based on the audit the of the ERP system, the final numbers are: ,408, ,215,300 Total procured- 2,215,300. Total distributed - 69% as of Sep 2013 Number of adults and children receiving ARVs Number Value Number of patients receiving The number treated was ARVs financed by the Project. higher than the targets, due to Hence the baseline is 0.00 some savings, that enabled the Ministry to purchase additional ARVs. The final numbers after the ERP audit are as follows: , ,266 Total - 123,266 Direct project beneficiaries Number Value Based on the ERP audit the final numbers are as follows: ,637, ,859, ,230,660 (Q3) Female beneficiaries Percentage Value Page 3 of 6

4 Sub Type Supplemental Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of orders received according to the Number Value agreed schedule in the contracts. This number is best represented as a percentage rather than a number as the number of orders are continually on the increase Based on the ERP audit, the final data are as follows: n/a baseline % % 2013 (Q3) - 31% Total average 49% 80% of the contracts received in the time agreed in the schedule. Percentage of supplier lead time variability Percentage Value The lead time variability was 103% which means that it took twice as long than originally forecasted for the supplies to be received. After the ERP audit here all the final numbers: The lower the lead-time variability the better for supply chain planning. The team anticipated high variability due to the customs clearances % % % Average - 80% National fleet management plan completed. Text Value No No Yes The fleet management assessment has been been completed as of Dec Awaiting the completion of the plan. Districts using a computerized LMIS Number Value Based on the audit here are the numbers: Page 4 of 6

5 Data on Financial Performance (as of 19-Feb-2014) Financial Agreement(s) Key s (baseline) Total as of Nov Project Ln/Cr/Tf Status Approval Signing Effectiveness Original Closing Revised Closing P IDA Effective 30-Sep Nov Feb Dec-2012 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P IDA Effective XDR Disbursement Graph Key Decisions Regarding Implementation The project has been extended till June 30, Restructuring History Level two Approved on 03-Oct-2012, Level 2 CD Decision on 23-Dec-2013 Page 5 of 6

6 Related Projects There are no related projects. Page 6 of 6