MADAGASCAR Emergency Support to Critical Education, Health, and Nutrition Services Project and Additional Financing Report No. 146625 JUNE 26, 2020 © 2020 International Bank for Reconstruction This work is a product of the staff of The World RIGHTS AND PERMISSIONS and Development / The World Bank Bank with external contributions. The findings, The material in this work is subject to copyright. 1818 H Street NW interpretations, and conclusions expressed in Because The World Bank encourages Washington DC 20433 this work do not necessarily reflect the views of dissemination of its knowledge, this work may be Telephone: 202-473-1000 The World Bank, its Board of Executive reproduced, in whole or in part, for Internet: www.worldbank.org Directors, or the governments they represent. noncommercial purposes as long as full attribution to this work is given. Attribution—Please cite the work as follows: The World Bank does not guarantee the World Bank. 2020. 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Report No.: 146625 PROJECT PERFORMANCE ASSESSMENT REPORT MADAGASCAR EMERGENCY SUPPORT TO CRITICAL EDUCATION, HEALTH, AND NUTRITION SERVICES PROJECT (P131945) AND ADDITIONAL FINANCING (P148749) June 26, 2020 Human Development and Economic Management Independent Evaluation Group Abbreviations DPT3 diphtheria, pertussis, and tetanus (third dose) IEG Independent Evaluation Group NGO nongovernmental organization ONN National Nutrition Office (Office National de Nutrition, Madagascar) SDR special drawing rights All dollar amounts are US dollars unless otherwise indicated. Director-General, Independent Evaluation Ms. Alison Evans Director, Human Development and Economic Management Mr. Oscar Calvo-Gonzalez Manager, Corporate and Human Development Ms. Galina Sotirova Task Manager Ms. Ann Elizabeth Flanagan This report was prepared by Denise Anne Vaillancourt, who assessed the project in October 2019, under the supervision of Ann Elizabeth Flanagan. Huguette Rabenitany provided technical support and local knowledge in Madagascar. The report was peer reviewed by Salim J. Habayeb and panel reviewed by Judyth L. Twigg. Gaby Loibl provided administrative support. ii Contents Data ........................................................................................................................................................................ v Summary ............................................................................................................................................................ vii 1. Project Background, Context, and Design .......................................................................................... 1 Project Background and Context ............................................................................................................ 1 Project Objective, Design, and Financing ............................................................................................4 2. What Worked, What Didn’t Work, and Why? ................................................................................... 9 Results .............................................................................................................................................................. 9 Education .................................................................................................................................................................... 10 School Health and Nutrition ................................................................................................................................. 11 Health ............................................................................................................................................................................ 11 Nutrition ...................................................................................................................................................................... 14 Impacts ........................................................................................................................................................................ 15 Design and Preparation ........................................................................................................................... 16 What Worked? .......................................................................................................................................................... 16 What Didn’t Work? .................................................................................................................................................. 18 Implementation and Supervision .......................................................................................................... 19 What Worked? .......................................................................................................................................................... 19 What Didn’t Work? ................................................................................................................................................. 20 3. Lessons .......................................................................................................................................................... 22 Prospective .................................................................................................................................................. 24 Bibliography ..................................................................................................................................................... 28 Boxes Box 1.1. Types of Malnutrition ........................................................................................................................ 2 Box 1.2. Definitions of Nutrition-Specific and Nutrition-Sensitive Interventions .......................... 7 Box 2.1. Findings and Recommendations of an Institutional Audit of the National Nutrition Office, 2016 ........................................................................................................................................................ 21 Tables Table 1.1. Planned versus Actual Costs by Component ......................................................................... 6 Table 2.1. Geographic Coverage of the Project by District, Commune, and Phase ..................... 9 iii Figure Figure 1.1. Simplified Theory of Change: Project Results Chain .......................................................... 8 Appendixes Appendix A. Project Ratings ...................................................................................................................... 33 Appendix B. Fiduciary, Environmental, and Social Aspects ............................................................ 55 Appendix C. Methods and Evidence ...................................................................................................... 57 Appendix D. Additional Data .................................................................................................................... 68 Appendix E. Results Framework and Key Outcome Indicators .................................................... 93 Appendix F. National Policies, Strategic Plans, and Budgets for Nutrition .............................. 97 Appendix G. World Bank Education, Health, and Nutrition Lending Portfolio, 1976–2018 ... 101 Appendix H. World Bank Education, Health, and Nutrition Analytical Work, 1996–2021 ....... 107 Appendix I. Data on Project Financing ................................................................................................ 114 Appendix J. Other Donors Supporting Nutrition in Madagascar .............................................. 116 Appendix K. Findings from an In-Depth Look at Nutrition.......................................................... 119 Appendix L. Borrower Comments ......................................................................................................... 127 iv Data This is a Project Performance Assessment Report by the Independent Evaluation Group of the World Bank Group on the Madagascar Emergency Support to Critical Education, Health, and Nutrition Services Project (P131945) and additional financing (P148749). This instrument and the methodology for this evaluation are discussed in appendix C. Following standard Independent Evaluation Group procedure, copies of the draft report were shared with relevant government officials for their review and comment Government comments are included in appendix L. Basic Data SDR42.2 million World Bank ($65 million); financing SDR6.5 million Country Madagascar commitment ($10 million) Global Practice Human Development Actual project cost $68,112,652 Project name Emergency Support to Critical Expected project $75,000,000 Education, Health, and Nutrition total cost Services Project and Additional Financing Project ID P131945, P148749