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World Bank Document Document of The World Bank Report No: ICR00003618 Public Disclosure Authorized IMPLEMENTATION COMPLETION AND RESULTS REPORT (IDA-50290 and MULT-16540) ON A CREDIT IN THE AMOUNT OF SDR 63.10 MILLION Public Disclosure Authorized (US$95.11 MILLION EQUIVALENT) AND A GRANT IN THE AMOUNT OF US$1.585 MILLION TO THE UNITED REPUBLIC OF TANZANIA Public Disclosure Authorized FOR A BASIC HEALTH SERVICES PROJECT (BHSP) April 21, 2017 Health, Nutrition and Population Global Practice Africa Region Public Disclosure Authorized CURRENCY EQUIVALENTS (Exchange Rate Effective February 2017) Currency Unit = Tanzania Shilling (TShs) TShs 1.00 = US$0.000465 US$ 1.00 = SDR0.725 FISCAL YEAR July 1 – June 30 ABBREVIATIONS AND ACRONYMS AF Additional Financing ANC Antenatal Care ASC Audit Sub-Committee BFC Basket Financing Committee BHSP Basic Health Services Project BRN Big Results Now CAG Controller and Auditor General CAS Country Assistance Strategy CBG Capacity Building Grant CDH Council District Hospital CCHPs Comprehensive Council Health Plans CHF Community Health Fund CHMT Council Health Management Team CHSB Community Health Service Board DbyD Decentralization by Devolution DHIS District Health Information System DHS Demographic and Health Survey DLI Disbursement Linked Indicator DMO District Medical Officer DPs Development Partners FM Financial Management GDP Gross Domestic Product GFATM Global Fund for AIDS, Tuberculosis and Malaria GOT Government of Tanzania GP Global Practice HBF Health Basket Fund HBS Household Budget Survey HCWM Health Care Waste Management HFGC Health Facility Governing Committee HIV/AIDS Human Immuno - Deficiency Virus/Acquired Immune Deficiency Syndrome HMIS Health Management Information System HRH Human Resources for Health i HRITF Health Resources Innovation Trust Fund HSDG Health Sector Development Grant HSDP Health Sector Development Project HSSP Health Sector Strategic Plan ICR Implementation Completion and Results IDA International Development Association IFR Interim Unaudited Financial Report IO Intermediate Outcome IMR Infant Mortality Rate ISR Implementation Status and Results JAHSR Joint Annual Health Sector Review LGAs Local Government Authorities LGDG Local Government Development Grant LGSP Local Government Support Project M&E Monitoring and Evaluation MDG Millennium Development Goal MESI Monitoring and Evaluation Strengthening Initiative MMR Maternal Mortality Ratio MNCH Maternal Neonatal and Child Health MOF Ministry of Finance MOHSW Ministry of Health and Social Welfare MOU Memorandum of Understanding MRP Maximum Retail Price MSD Medical Stores Department MTR Mid Term Review NHIF National Health Insurance Fund OC Other Charges ODI Overseas Development Institute OIG Office of the Inspector General OPD Outpatient Department P4P Pay for Performance PAD Project Appraisal Document PBF Performance Based Financing PDO Project Development Objective PE Personnel Emolument PFM Public Financial Management PforR Program for Results PHC Primary Health Care PMO-RALG Prime Minister’s Office–Regional Administration and Local Government PPA Public Procurement Act PPRA Public Procurement Regulatory Authority QER Quality Enhancement Review RBF Results Based Financing RHMT Regional Health Management Team RMNCH Reproductive, Maternal, Neonatal and Child Health ii SDG Service Delivery Grant SDI Service Delivery Indicator SDR/XDR Special Drawing Rights SIM Sector Investment and Maintenance Loan SOE Statement of Expenditure SPHCRP Strengthening Primary Health Care for Results Program SWAp Sector Wide Approach TB Tuberculosis TF Trust Fund TFDA Tanzania Food and Drug Authority TFR Total Fertility Rate TTL Task Team Leader TShs Tanzanian Shillings TWG Technical Working Group U5MR Under-five Mortality Rate VAH Voluntary Agency Hospital UNFPA United Nations Population Fund UNICEF United Nations Children's Fund US$ United States Dollar Senior Global Practice Director: Timothy Grant Evans Country Director: Bella Bird Practice Manager: Magnus Lindelow Project Team Leader: Gayle Martin ICR Team Leader: Gayle Martin ICR Author: Iffat Mahmud iii COUNTRY Tanzania Basic Health Services Project CONTENTS Datasheet ............................................................................................................................. v 1. Project Context, Development Objectives and Design ................................................... 1 2. Key Factors Affecting Implementation and Outcomes .................................................. 6 3. Assessment of Outcomes .............................................................................................. 17 4. Assessment of Risk to Development Outcome ............................................................. 27 5. Assessment of Bank and Borrower Performance ......................................................... 28 6. Lessons Learned............................................................................................................ 30 7. Comments on Issues Raised by Borrower/Implementing Agencies/Partners............... 31 Annex 1. Project Costs and Financing .............................................................................. 33 Annex 2. Outputs by Component...................................................................................... 34 Annex 3. Economic and Financial Analysis ..................................................................... 38 Annex 4. Bank Lending and Implementation Support/Supervision Processes ................. 45 Annex 5. Summary of Borrower's ICR ............................................................................. 47 Annex 6. Comments of Co-financiers and Other Partners/Stakeholders .......................... 58 Annex 7. Disbursement mechanism and allocation conditions of HBF ........................... 59 Annex 8. Issues with results framework indicators .......................................................... 61 Issues with the PDO indicators ......................................................................................... 61 Issues with data reported in the ISRs ................................................................................ 62 Lack of quality data: ......................................................................................................... 62 Annex 9. (A) Systemic Deficiencies of MSD and (B) Steps initiated by MSD to address stock-outs .......................................................................................................................... 64 Annex 10. Achievement of indicators against target ........................................................ 67 Annex 11: Data used for the results chain ........................................................................ 69 Annex 12. BHSP’s fund flow arrangement ...................................................................... 70 Annex 13. List of Supporting Documents and People Consulted .................................... 71 iv Datasheet A. Basic Information Tanzania - Basic Health Country: Tanzania Project Name: Services Project Project ID: P125740 L/C/TF Number(s): IDA-50290 ICR Date: 04/21/2017 ICR Type: Core ICR GOVERNMENT OF Lending Instrument: SIM Borrower: TANZANIA Original Total XDR 63.10M Disbursed Amount: XDR 63.08M Commitment: Revised Amount: XDR 63.10M Environmental Category: B Implementing Agencies: Ministry of Health and Social Welfare Project Coordinator Regional Administration and Local Government Cofinanciers and Other External Partners: UNICEF Canada High Commission UNFPA KFW Entiwicklungsbank DANIDA Irish Aid Swiss Development Cooperation B. Key Dates Revised / Actual Process Date Process Original Date Date(s) Concept Review: 03/08/2011 Effectiveness: 03/02/2012 05/13/2015 Appraisal: 06/27/2011 Restructuring(s): 04/29/2016 Approval: 12/20/2011 Mid-term Review: 09/30/2014 09/30/2014 Closing: 06/30/2015 10/30/2016 C. Ratings Summary C.1 Performance Rating by ICR Outcomes: Moderately Unsatisfactory Risk to Development Outcome: Moderate Bank Performance: Unsatisfactory v Borrower Performance: Moderately Unsatisfactory C.2 Detailed Ratings of Bank and Borrower Performance (by ICR) Bank Ratings Borrower Ratings Moderately Quality at Entry: Government: Moderately Satisfactory Unsatisfactory Implementing Moderately Quality of Supervision: Unsatisfactory Agency/Agencies: Unsatisfactory Overall Bank Overall Borrower Moderately Unsatisfactory Performance: Performance: Unsatisfactory C.3 Quality at Entry and Implementation Performance Indicators Implementation QAG Assessments Indicators Rating Performance (if any) Potential Problem Project Quality at Entry No None at any time (Yes/No): (QEA): Problem Project at any Quality of Yes None time (Yes/No): Supervision (QSA): DO rating before Moderately Closing/Inactive status: Unsatisfactory D. Sector and Theme Codes Original Actual Major Sector/Sector Public Administration Public administration - Health 3 3 Sub-National Government 12 12 (Historic)Health and other social services Health 85 85 Major Theme/Theme/Sub Theme Human Development and Gender Health Systems and Policies 70 70 Health System Strengthening 70 70 Public Sector Management Public Administration 30 30 Municipal Institution Building 30 30 E. Bank Staff Positions At ICR At Approval Vice President: Makhtar Diop Obiageli Katryn Ezekwesili vi Country Director: Bella Deborah Mary Bird Mercy Miyang Tembon Practice Magnus Lindelow Jean J. De St Antoine Manager/Manager: Project Team Leader: Gayle Martin Dominic S. Haazen ICR Team Leader: Gayle Martin ICR Primary Author: Iffat Mahmud F.
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