World Bank Document

The World Bank Report No: ISR15055

Implementation Status & Results Uganda Uganda Health Systems Strengthening Project (P115563)

Operation Name: Uganda Health Systems Strengthening Project (P115563) Project Stage: Implementation Seq.No: 9 Status: ARCHIVED Archive Date: 21-Jun-2014 Country: Uganda Approval FY: 2010

Public Disclosure Authorized Product Line:IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of Health Key Dates Board Approval Date 25-May-2010 Original Closing Date 31-Jul-2015 Planned Mid Term Review Date 14-Apr-2013 Last Archived ISR Date 26-Dec-2013 Public Disclosure Copy Effectiveness Date 10-Feb-2011 Revised Closing Date 31-Jul-2015 Actual Mid Term Review Date 02-Apr-2013

Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective (PDO) is to deliver the Uganda National Minimum Health Care Package (UNMHCP) to Ugandans, with a focus on maternal health, newborn care and family planning. This will be through improving human resources for health, physical health infrastructure, and management, leadership and accountability for health service delivery. Has the Project Development Objective been changed since Board Approval of the Project?

Public Disclosure Authorized Yes No

Component(s)

Component Name Component Cost Improved health workforce 5.00 Improved health infrastructure of existing facilities. 85.00 Improved management and leadership 10.00 Improved maternal, newborn and family planning services. 30.00

Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Public Disclosure Authorized Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Substantial Substantial

Implementation Status Overview Public Disclosure Copy 1. Project implementation over the last six months was on track. The project has consistently achieved annual targets for four of the five PDO indicators and is making satisfactory progress towards achievement of its development objective.

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2. The contracts for the renovation of the nine hospitals under Phase I were signed and civil works started and medical equipment procured by the project were distributed to a total of 230 health facilities. The implementation of the scholarship program and training of hospital managers is progressing well, and the training and mentorship of front-line health workers in provision of emergency obstetric care and long term permanent methods of family planning as well as the roll-out of maternal and peri-natal death reviews have picked up pace.

The negotiations for the Additional Financing (US$ 90 million) were successfully concluded in January 2014. With the passing of the Anti-homosexuality Act in February 2014, the World Bank postponed the approval of the AF pending due diligence to assess impact of the new law on the achievement of the project development objectives.

Locations Country First Administrative Division Location Planned Actual Uganda Ntungamo District Rubaare Public Disclosure Copy Uganda Ntungamo District Rubaare

Uganda Pallisa District Pallisa

Uganda Arua District Pakwach

Uganda Kitgum District Padibe

Uganda Adjumani District Obongi

Uganda Luwero District Ntenjeru

Uganda Mukono District Ntenjeru

Uganda Nakaseke District Ngoma

Uganda Nebbi District Nebbi

Uganda Not Entered Nankoma

Uganda Not Entered Nankoma Public Disclosure Copy Uganda Nakaseke District Nakaseke

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Country First Administrative Division Location Planned Actual Uganda Nakaseke District Nakaseke

Uganda Not Entered Mwizi

Uganda Not Entered Mwera

Uganda Mityana District Mwera

Public Disclosure Copy Uganda Mubende District Mubende

Uganda Mubende District Mubende

Uganda Moyo District Moyo

Uganda Moroto District Moroto

Uganda Mubende District Mityana

Uganda Masindi District Masindi

Uganda Kamuli District Kiyunga

Uganda Not Entered Kiyunga

Uganda Not Entered Kitwe

Uganda Kitgum District Kitgum

Public Disclosure Copy Uganda Masindi District Kiryandongo

Uganda Masindi District Kiryandongo

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Uganda Not Entered Kikamulo

Uganda Kaliro District Kiganda

Uganda Not Entered Kiganda

Uganda Pallisa District Kibuku

Uganda Not Entered Kawolo Station Public Disclosure Copy Uganda Mubende District Kasanda

Uganda Mubende District Kasanda

Uganda Kiruhura District Kabuyanda

Uganda Iganga District Iganga

Uganda Wakiso District Entebbe

Uganda Ntungamo District Chitwe

Uganda Masindi District Bwijanga

Uganda Not Entered Buyinja

Uganda Jinja District Buwenge

Uganda Mukono District Buvuma Island

Uganda Masindi District Bulisa Public Disclosure Copy Uganda Masindi District Bulisa

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Uganda Bukwa District Bukwa

Uganda Not Entered Bugongo

Uganda Bugiri District Bugiri

Uganda Not Entered Budondo Public Disclosure Copy Uganda Not Entered Budondo

Uganda Pallisa District Budaka

Uganda Nebbi District Atyak

Uganda Gulu District Atiak

Uganda Apac District Apac

Uganda Gulu District Anaka

Uganda Apac District Aduku

Uganda Apac District Aboke

Uganda Ntungamo District Ntungamo District

Uganda Isingiro District Isingiro District

Uganda Mityana District Mityana District

Public Disclosure Copy Results

Project Development Objective Indicators

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Indicator Name Core Unit of Measure Baseline Current End Target People with access to a basic package of Number Value 0.00 274900.00 70000.00 health, nutrition, or reproductive health services Date 04-Oct-2009 30-Apr-2014 31-Jul-2015 (number) Comments Shall use proxy indicator: Target will be revised during patient visits in renovated the additional financing. The health facilities - in and out data are from project patients supported hospitals only unlike the previous year. Deliveries taking place in Government and Percentage Value 34.00 41.00 45.00 PNFP Health Facilities (%) Date 30-Oct-2009 30-Apr-2014 31-Jul-2015 Comments

Public Disclosure Copy Baseline 2012/13 Mothers attending at least 4 antenatal care Percentage Value 50.00 31.00 65.00 (ANC) visits (%) Date 29-Dec-2006 30-Apr-2014 31-Jul-2015 Comments Baseline Based on the HMIS. It under- reports the actual value compared to the DHS. As part of the Additional Financing, this indicator will be dropped due to measurement challenges. Contraceptive Prevalence Rate Percentage Value 24.00 30.00 35.00 Date 29-Dec-2006 30-Jun-2014 31-Jul-2015 Comments From DHS. Direct project beneficiaries Number Value 0.00 137458.00 70000.00 Date 31-Dec-2009 30-Apr-2014 31-Jul-2015 Comments Shall use proxy indicator: patient visits in renovated health facilities - in and out patients

Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Health personnel receiving training (number) Number Value 0.00 821.00 75.00 Date 04-Oct-2009 30-Apr-2014 31-Jul-2015 Comments Baseline Health facilities constructed, renovated, and/or Number Value 0.00 219.00 46.00

Public Disclosure Copy equipped (number) Date 04-Oct-2009 30-Apr-2014 31-Jul-2015

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Comments Baseline The contracts for the renovation of the nine hospitals under Phase I were signed and civil works started. Distribution of medical equipment procured by the project is complete. Approved positions filled by qualified health Percentage Value 56.00 63.00 80.00 workers Date 30-Oct-2009 30-Apr-2014 31-Jul-2015 Comments Baseline Health workers receiving a salary within two Percentage Value 0.00 46.00 30.00 Public Disclosure Copy months from reporting to work Date 04-Oct-2009 30-Apr-2014 31-Jul-2015 Comments HC IVs and Hospitals with functioning minimum Number Value 0.00 0.00 58.00 Essential Equipment Date 04-Oct-2009 30-Apr-2014 31-Jul-2015 Comments This is a complex indicator, which duplicates other indicator on equipment. Shall be dropped during the AF. Hospitals and HC IVs offering comprehensive Percentage Value 20.00 30.00 50.00 emergency obstetric care Date 04-Oct-2009 30-Apr-2014 31-Jul-2015 Comments Source: Resource Center HC IV facilities conducting maternal and Percentage Value 5.00 0.00 40.00 perinatal death audits Date 04-Oct-2009 30-Apr-2014 31-Jul-2015 Comments Data Not Available Health facilities with Client Charters Percentage Value 0.00 23.00 100.00 Date 04-Oct-2009 30-Apr-2014 31-Jul-2015 Comments Health facilities without stock-outs of tracer Percentage Value 26.00 53.00 55.00 medicines and supplies Date 04-Oct-2009 30-Apr-2014 31-Jul-2015 Comments Source: 2012/2013 AHSPR. Please note that the target in 2011/12 was 48% and not 70%. Hospitals with medical superintendents trained Percentage Value 0.00 75.00 100.00 in health management/hospital administration Date 04-Oct-2009 30-Apr-2014 31-Jul-2015 Public Disclosure Copy Comments

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Drug Orders processed timely by National Percentage Value 55.00 100.00 80.00 Medical Stores Date 04-Oct-2009 30-Apr-2014 31-Jul-2015 Comments Source: NMS. This indicator is to be dropped as NMS has changed to a push from a pull system. Pregnant women receiving antenatal care Number Value 1200000.00 0.00 1400000.00 during a visit to a health provider (number) Date 30-Oct-2009 30-Apr-2014 31-Jul-2015 Comments Will be updated when new data is available after July 31, 2014. Public Disclosure Copy Couple years of protection Number Value 549594.00 0.00 1000000.00 Date 30-Oct-2009 30-Apr-2014 31-Jul-2015 Comments Will be updated when new data is available after July 31, 2014. Health Center IV Performing Caesarian Percentage Value 14.00 30.00 50.00 Sections Date 30-Oct-2009 30-Apr-2014 31-Jul-2015 Comments Source: MoH RH Division Report Health Center IV and Hospitals Renovated Number Value 0.00 0.00 46.00 according to agreed standards Date 30-Oct-2009 30-Apr-2014 31-Jul-2015 Comments Renovations started but not yet completed

Data on Financial Performance (as of 01-Apr-2014)

Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P115563 IDA-47420 Effective 25-May-2010 12-Aug-2010 10-Feb-2011 31-Jul-2015 31-Jul-2015

Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P115563 IDA-47420 Effective XDR 85.70 85.70 0.00 33.18 52.52 39.00

Disbursement Graph Public Disclosure Copy

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Key Decisions Regarding Implementation N/A

Restructuring History There has been no restructuring to date.

Related Projects P145280-Uganda Health Systems Strengthening Project AF Public Disclosure Copy

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