Implementation Status & Results Cambodia KH-Health Sector Support Project (P070542)

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1 Public Disclosure Authorized Public Disclosure Authorized The World Bank Implementation Status & Results Cambodia KH-Health Sector Support Project (P070542) Operation Name: KH-Health Sector Support Project (P070542) Project Stage: Implementation Seq.No: 15 Status: ARCHIVED Archive : 05-Apr-2011 Country: Cambodia Approval FY: 2003 Product Line: IBRD/IDA Region: EAST ASIA AND PACIFIC Lending Instrument: Sector Investment and Maintenance Loan Implementing Agency(ies): Ministry of Health Key s Board Approval 19-Dec-2002 Original Closing 31-Dec-2007 Planned Mid Term Review 01-Mar-2006 Last Archived ISR 05-Apr-2011 Effectiveness 14-Aug-2003 Revised Closing Actual Mid Term Review 02-Oct-2006 Project Development Objectives Project Development Objective (from Project Appraisal Document) The objective of this project is to contribute to the improvement of the health status of the population by: (a) increasing the accessibility and the quality of health services; and (b) assisting the Kingdom of Cambodia to implement its Health Sector Strategic Plan and strengthen the sector's capacity to manage resources efficiently. 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 IMPROVED DELIVERY OF HEALTH SERVICES (FOR THE BENEFIT OF THE POOR AND RURAL POPULATION) IMPROVED PROGRAMS ADDRESSING PUBLIC HEALTH PRIORITIES STRENGTHENED INSTITUTIONAL CAPACITY 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 Implementation Status Overview This is the final ISR. Health Sector Support Project (HSSP1) closed on December 31, 2011, following a one-year extension to allow completion of remaining civil works, all other activities that were financed by HSSP1 were transferred to Second Health Sector Support Program (HSSP2) since April1, As noted below, most civil works were completed by the closing date, but completion of remaining construction for Preah Vihear Referral Hospital, the National Drug Quality Control Laboratory, and 12 Health Centers will be financed by HSSP2 Pooled Fund from January 1, The MOH commissioned an independent evaluation of HSSP1 in 2010, which concluded that the Project had substantially met its Page 1 of 8

2 development objectives. A final Results and Implementation Completion Report (ICR) will be completed by June The overall progress toward the development objective is rated moderately satisfactory, based on substantial progress toward reaching most of PDO indicators and implementation result indicators, which contributed to substantial progress on improving accessibility, coverage and quality of services; substantial progress toward assisting RGC in implementing its HSP1 and HSP2, and modest progress toward strengthening sector capacity to manage resources efficiently. At the sector level, progress has been substantial in terms of improved health outcomes and MDGs. The country already has met the Cambodia MDG 4 (CMDG 4) and the National Strategic Development Plan (NSDP) targets for child mortality reduction for Between 2000 and 2010, under-5 and infant mortality rate declined from 124 and 95 per 1,000 live births to 54 and 45 per 1,000 live births, respectively. Between 2005 and 2010, the maternal mortality ratio declined from 472 deaths per 100,000 live births to an estimated 206 deaths per 100,000 live births (CDHS 2010) due in part to dramatic increase in skilled birth attendance and facility-based deliveries. In addition, fertility rates declined from 4.0 in 2000 to 3.0 in 2010, while modern contraceptive prevalence increased to 35% in 2010, although short of the CMDG target of 44% for Despite this impressive progress, Cambodia remains off track for nutrition-related targets of the CMDG 1 and the NSDP. Cambodia has the 13th highest prevalence of stunted children in the world, and the highest in the region. The 2010 CDHS found that 28% of children are underweight, with no improvement since Moreover, the percentage of wasted children has increased slightly since The rate of stunting in children from the poorest households is 51.1% compared to 23.1% for children from the richest households. Food insecurity for the poor; inadequate child feeding (76% of children do not receive appropriate feeding), hygiene and sanitation practices, and inadequate access/utilization of health services for childhood diseases and acute malnutrition contribute to the significant proportion of under nutrition in young children. Despite impressive results achieved in the area of HIV/AIDS, Cambodia is among the countries hardest hit by the epidemic in the region, with 0.7% of adults affected in 2010, compared to 1.8% in HSSP1 was the primary source of financing for dengue during the implementation period. The case fatality rate for dengue has declined significantly during Project implementation from 1.2% between to 0.3% in 2009 and Throughout the project lifespan, the World Bank credit financed the construction and renovation of 44 health centers and health posts, mostly in remote areas, (of which 32 had been completed and other 12 are expected to be completed by the end of quarter one 2012); 7 referral hospitals (6 of them had been completed); the construction of the training center for the National Malaria Control Program and the Information Center for the National Center for HIV/AIDS and Dermatology and STD (had been completed), and the construction of the National Laboratory for Drug Quality Control (under progress). The contract for construction supervision was amended on June 13, 2011 to expand the supervision to cover the construction of 12 health centers in six provinces after contracts for the construction signed in early June Medical equipment have been supplied and installed at Referral Hospital Ochrov, Stung Treng and Kampot, and these three hospitals are fully operational. Locations Country First Administrative Division Location Planned Actual Cambodia Not Entered Khett Pouthisat Cambodia Not Entered Khett Batdambang Cambodia Not Entered Srok Stoung Cambodia Not Entered Khett Stoeng Treng Cambodia Not Entered Otar Meanchey Cambodia Not Entered Khett Preah Vihear Cambodia Not Entered Phnum Tbeng Meanchey Cambodia Not Entered Khett Pailin Cambodia Not Entered Srok Odongk Page 2 of 8

3 Country First Administrative Division Location Planned Actual Cambodia Not Entered Khett Kracheh Cambodia Not Entered Srok Kong Pisei Cambodia Not Entered Khett Keb Cambodia Not Entered Khett Kampot Cambodia Not Entered Khett Kampong Thum Cambodia Not Entered Kampong Thum Cambodia Not Entered Khett Kampong Spoe Cambodia Not Entered Khett Banteay Mean Choay Cambodia Not Entered Sampov Meas Cambodia Not Entered Baray Cambodia Not Entered Santuk Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Maternal mortality ratio (per 100,000 live births) Text Value 437 (1997) 206 (2010 CDHS) Target values for CMDG By 2005: 343 By 2010: 243 By 2015: May Dec-2010 Achieved the initial CMDG interim target of maternal mortality ratio of 243/100,000 live births by The original PAD did not include targets for key indicators. CMDG and NSDP targets were therefore adopted for outcome indicators, and Health Strategic 1&2 targets for other indicators. Page 3 of 8

4 Fertility rate Text Value 4.0 (2000 DHS) 3.0 (2010 CDHS) Target values for CMDG By 2005: 3.8 By 2010: 3.4 By 2015: Dec-1998 Achieved CMDG target by Malnutrition rate among children under 5 years of age Text Value Stunting 45% (2000 DHS) Wasting 15% (2000 DHS) Underweight 45% (2000 DHS) 2000 (DHS) 31-Dec-2000 Stunting 39.90% (2010 CDHS) Wasting 10.9% (2010 CDHS) Underweight 28.30% (2010 CDHS) Off track to achieve CMDG interim target values for 2010 for stunting and wasting. Target values for CMDG Stunting 35% by 2005, 28% by 2010, 22% by 2015 Wasting 13% by 2005, 10% by 2010, 9% by 2015 Underweight 36% by 2005, 29% by 2010, 22% by 2015 Child mortality rate (under 5 mortality rate) Text Value 124 (2000 CHS) 54 (2010 CDHS) Target values for CMDG By 2005: 105 By 2010: 85 By 2015: 65 Exceeded CMDG target values for 2010 and Intermediate Results Indicators Page 4 of 8

5 Indicator Name Core Unit of Measure Baseline Current End Target HIV prevalence among years old Text Value 2003: 1.9% (NCHADS 2004) 0.7% (JAPR 2011) Target values for CMDG By 2005: 2.3% By 2010: 2.0% By 2015: 1.8% 31-Dec Feb-2011 Exceeded CMDG target values for 2010 and Malaria case fatality rate (severe case only) treated in public facilities per 100 patients Incedence of malaria per 1,000 inhabitants in high risk areas Percentage of children under 1 year fully immunized Text Value 2002: 10.85% (HMIS) 0.22% (JAPR 2011) Target values for CMDG By 2005: 0.3% By 2010: 0.25% By 2015: 0.1% Achieved CMDG interim target value by Text Value 2002:8.6 (HMIS) 3.34/1,000 ihnabitants (2010 result, JAPR 2011) Achieved 2010 target value of Health Strategic Plan CMDG indicator is Malaria case fatality rate reported by public health sector (%). Health Strategic Plan : By 2010: 3.58/1,000 inhabitants By 2015: 2.16/1,000 inhabitants Not CMDG target indicator. The indicator in health Strategic Plan is Incidence of malaria reported at public health facilities per 1,000 population. Text Value 39% (2000 DHS) 73.6% (2010 CDHS) Health Strategic Plan : By 2010: 70% By 2015: 80% Achieved target value of Health Strategic Plan for Target was taken from Health Strategic Plan M&E framework. Page 5 of 8

6 Percentage of pregnant women received at least 2 ANC consultation Percentage of married women aged years using modern contraceptive in public health services Percentage of deliveries attended by trained staff Improved capacity of health centers (full MPA capacity) Improved capacity of Referral Hospitals (achieved CPA2 & CPA3 levels) Text Value 2002:29% (HMIS) 72% (2010 result, JAPR 2011) Significant progress, but fell short of CMDG target value for Target values for CMDG By 2005: 60% By 2010: 75% By 2015: 90% Text Value 2002:17% (HMIS) 35% (2010 CDHS) Target values for CMDG By 2005: 30% By 2010: 44% By 2015: 60% Off tract to achieve CMDG interim target value for Text Value 20% (HMIS) 69.6% (2010 result, JAPR 2011) Achieved CMDG interim target value for Target values for CMDG By 2005: 60% By 2010: 70% By 2015: 80% Text Value 294 (HMIS 2003) 470/965 set for 2006 annual operational plan (JAPR 2007) 31-Dec Dec Dec-2006 This indicator was dropped from the monitoring framework of health Strategic Plan Text Value N/A 56/89 Referral Hospitals (JAPR 2011) 31-Mar-2002 Increased from 45/79 Referral Hospitals in JAPR Target is currently not available. Definition was not clear and difficult to monitor. 47/67 RH set for 2006 annual operational plan (JAPR 2007) Target is currently not available. Page 6 of 8

7 Disbursement of MOH budget expenditures Text Value 102.6% (Disbursement of national budget, JAPR 2011) 31-Aug-2003 No target value set. Pulmonary TB Smear (+) case detection rate Pulmoniary TB cure rate Per capita consultation rate in public facilities (new cases) Text Value Smear (+) case detection rate: 57% (2002) Pulmonary TB cure rate: NA 31-Mar-2002 All estimated new smearpositive TB cases detected under DOTS (%): 66% Registered smear-positive TB cases successfully treated under DOTD (%) : 91% (JAPR 2011) Off track to achieve case detection rate. Achieved target for cure rate. Target values for CMDG All estimated new smearpositive TB cases detected under DOTS (%):70% by 2005, >70% by 2010 and Registered smear-positive TB cases successfully treated under DOTD (%): >85% by 2005, 2010 and CMDG target indicators are All estimated new smearpositive TB cases detected under DOTS (%) and Registered smear-positive TB cases successfully treated under DOTS (%) Text Value 2002: 0.38 (nationwide) 0.63 (2010 result, JAPR 2011) 2006: 0.5 (per Annual Operatoional Plan 2006) 31-Mar Dec-2010 Achieved target of 0.6 for target value for Health Strategic Plan for year 2010 is 0.6 Data on Financial Performance (as of 30-Jan-2012) Financial Agreement(s) Key s Project Loan No. Status Approval Signing Effectiveness Closing P IDA Closed 19-Dec Feb Aug-2003 P IDA-H0150 Closed 19-Dec Feb Aug Dec-2009 P IDA-H0160 Closed 19-Dec Feb Aug Dec-2009 P TF Closed 30-Jun Jun Jun Dec-2008 Disbursements (in Millions) Page 7 of 8

Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P070542 IDA-37280 Closed USD 17.20 17.20 0.00 19.08 0.84 111.00 P070542 IDA-H0150 Closed USD 7.80 7.78 0.

8 Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P IDA Closed USD P IDA-H0150 Closed USD P IDA-H0160 Closed USD P TF Closed USD Disbursement Graph Key Decisions Regarding Implementation According to the World Bank Policy on Access to Information, this disclosable information in the ISR should be shared with the public. Restructuring History Level two Approved on 16-Dec-2010 Related Projects There are no related projects. Page 8 of 8

Implementation Status & Results Africa Horn of Africa Emergency Health and Nutrition Project (P127949)

Public Disclosure Authorized Public Disclosure Authorized Implementation Status & Results Africa Horn of Africa Emergency Health and Nutrition Project (P127949) Operation Name: Horn of Africa Emergency