The World Bank Report No: ISR10749

Implementation Status & Results Second Women's Health & Safe Motherhood (P079628)

Operation Name: Second Women's Health & Safe Motherhood (P079628) Project Stage: Implementation Seq.No: 16 Status: ARCHIVED Archive Date: 25-Jun-2013 Country: Philippines Approval FY: 2005

Public Disclosure Authorized Product Line:IBRD/IDA Region: EAST ASIA AND PACIFIC Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 21-Apr-2005 Original Closing Date 30-Jun-2012 Planned Mid Term Review Date 01-Oct-2008 Last Archived ISR Date 17-Mar-2013 Public Disclosure Copy Effectiveness Date 28-Dec-2005 Revised Closing Date 30-Jun-2013 Actual Mid Term Review Date 31-Oct-2008

Project Development Objectives Project Development Objective (from Project Appraisal Document) The project will contribute to the national goal of improving women's health by: 1) Demonstrating in selected sites a sustainable, cost-effective model of delivering health services that increases access of disadvantaged women to acceptable and high quality reproductive health services and enables them to safely attain their desired spacing and number of children. 2)Establishing the core knowledge base and support systems that can facilitate countrywide replication of the project experience as part of mainstream approaches to reproductive health care within the framework of the Health Sector Reform Agenda Public Disclosure Authorized Has the Project Development Objective been changed since Board Approval of the Project?

Yes No

Component(s)

Component Name Component Cost Local Delivery of the Integrated WHSM Service Package 7.00 National Capacity to Sustain WHSM Services 9.00

Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Unsatisfactory

Public Disclosure Authorized Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Unsatisfactory Overall Risk Rating Substantial Substantial

Implementation Status Overview This is the last update before project closure on June 30, 2013. Public Disclosure Copy

The project has demonstrated that a service package of women's health services can be implemented at the local level (through a network of Basic/Comprehensive Emergency

Page 1 of 13 Public Disclosure Authorized The World Bank Report No: ISR10749

Obstetric and Neonatal Care [B/CEmONC] centers) and benefit targeted women. Expectant mothers are encouraged and assisted to develop birth plans which helps them and their spouses determine the type of services that they expect to get at the health facility and more importantly where they should go for delivery. The birth plan directs the mother to deliver in the most accessible health facility that is manned by trained health professionals. The project also demonstrated that some form of financial sustainability could be achieved by health facilities that have accreditation with PhilHealth on their maternity care package.

Although meant as a pilot, the concept of the Women's Health and Safe Motherhood (WHSM) service package has been demonstrated to be an effective intervention as it has been adopted by the national government as the approach to delivering health services at the local level for disadvantaged women. This was the result of a policy shift (to address the slow decline of maternal mortality rates) that believed that all pregnancies have some form of risk and thus should be delivered in a health facility by trained professionals (previously only identified high-risk pregnancies were referred to health facilities). To this end the project has successfully established a network of training institutions to train health teams in the B/ CEmONC concept. The project has also demonstrated that the regular use of project monitoring information can be used effectively with a system of regular planning using incremental targets over a predetermined amount of time (Rapid Results Approach).

However, the project falls short of fully demonstrating the full benefits of this approach as it has failed to meet several crucial indicators. Due to slow accreditation of health facilities Public Disclosure Copy under PhilHealth's maternity care package, some B/CEmONCs have failed to maximize the financial benefits of accreditation. Furthermore, the project has failed to improve contraceptive prevalence rates, particularly in permanent methods, in all project sites thus failing to promote desired birth spacing and the number of desired children. The project has also failed to demonstrate unique approaches to dealing with special groups like the overseas foreign workers, free-lance commercial sex workers and adolescents.

Procurement delays have affected the conduct of two critical surveys - the end-line and BEmONC functionality assessment survey. Though the DOH has committed to undertake the surveys even after the project's closing date, it has been made clear to the DOH that these will no longer be eligible for project financing.

Locations Country First Administrative Division Location Planned Actual Philippines Bicol Virac ✔

Philippines Bicol Viga ✔

Philippines Bicol Uson ✔

Philippines Valley ✔

Philippines Bicol Tiwi ✔

Philippines Caraga Tandag ✔

Philippines Caraga Tago ✔

Philippines Caraga Tagbina ✔

Philippines Bicol Tabaco ✔

Philippines Bicol Sorsogon ✔

Philippines Santo Tomas ✔

Public Disclosure Copy Philippines Bicol Santo Domingo ✔

Philippines Cagayan Valley Santiago ✔

Page 2 of 13 The World Bank Report No: ISR10749

Country First Administrative Division Location Planned Actual Philippines Cagayan Valley Santa Maria ✔

Philippines Bicol Santa Magdalena ✔

Philippines Bicol San Pascual ✔

Philippines Cagayan Valley San Pablo ✔

Philippines Bicol San Miguel ✔

Philippines Caraga San Miguel ✔

Public Disclosure Copy Philippines Cagayan Valley San Mateo ✔

Philippines Cagayan Valley San Mariano ✔

Philippines Cagayan Valley San Manuel ✔

Philippines Bicol San Jacinto ✔

Philippines Cagayan Valley San Isidro ✔

Philippines Cagayan Valley ✔

Philippines Bicol San Fernando ✔

Philippines Bicol San Andres ✔

Philippines Cagayan Valley San Agustin ✔

Philippines Caraga San Agustin ✔

Philippines Cagayan Valley Roxas ✔

Philippines Cagayan Valley Reina Mercedes ✔

Philippines Bicol Rapu-Rapu ✔

Philippines Cagayan Valley Ramon ✔

Philippines Cagayan Valley ✔

Philippines Cagayan Valley Quezon ✔

Philippines Bicol Prieto Diaz ✔

Public Disclosure Copy Philippines Bicol Polangui ✔

Philippines Bicol Placer ✔

Page 3 of 13 The World Bank Report No: ISR10749

Philippines Bicol Pio V. Corpuz ✔

Philippines Bicol Pio Duran ✔

Philippines Bicol Pilar ✔

Philippines Bicol Panganiban ✔

Philippines Bicol Pandan ✔

Philippines Bicol Palanas ✔

Philippines Cagayan Valley ✔ Public Disclosure Copy Philippines Bicol Oas ✔

Philippines Cagayan Valley Naguilian ✔

Philippines Bicol Monreal ✔

Philippines Bicol Mobo ✔

Philippines Bicol Milagros ✔

Philippines Bicol Matnog ✔

Philippines Bicol Province of Masbate ✔

Philippines Bicol Masbate ✔

Philippines Caraga Marihatag ✔

Philippines Bicol Manito ✔

Philippines Bicol Mandaon ✔

Philippines Cagayan Valley ✔

Philippines Bicol Malinao ✔

Philippines Bicol Malilipot ✔

Philippines Cagayan Valley Magsaysay ✔

Philippines Bicol Magallanes ✔

Philippines Caraga Madrid ✔ Public Disclosure Copy Philippines Cagayan Valley ✔

Page 4 of 13 The World Bank Report No: ISR10749

Philippines Cagayan Valley Luna ✔

Philippines Caraga Lingig ✔

Philippines Bicol Libon ✔

Philippines Caraga Lianga ✔

Philippines Not Entered Legaspi City ✔

Philippines Caraga Lanuza ✔

Philippines Bicol Juban ✔ Public Disclosure Copy Philippines Bicol Jovellar ✔

Philippines Cagayan Valley Jones ✔

Philippines Western Visayas ✔

Philippines Bicol Irosin ✔

Philippines Cagayan Valley ✔

Philippines Caraga Hinatuan ✔

Philippines Bicol Guinobatan ✔

Philippines Bicol Gubat ✔

Philippines Bicol Gigmoto ✔

Philippines Cagayan Valley Gamu ✔

Philippines Bicol Esperanza ✔

Philippines Cagayan Valley ✔

Philippines Bicol Donsol ✔

Philippines Cagayan Valley Divilican ✔

Philippines Cagayan Valley Dinapigui ✔

Philippines Bicol Dimasalang ✔

Philippines Bicol Daraga ✔ Public Disclosure Copy Philippines Caraga Cortes ✔

Page 5 of 13 The World Bank Report No: ISR10749

Philippines Cagayan Valley Cordon ✔

Philippines Bicol Claveria ✔

Philippines Bicol Cawayan ✔

Philippines Cagayan Valley Cauayan ✔

Philippines Bicol Province of Catanduanes ✔

Philippines Bicol Cataingan ✔

Philippines Bicol Castilla ✔ Public Disclosure Copy Philippines Bicol Casiguran ✔

Philippines Caraga Carrascal ✔

Philippines Caraga Carmen ✔

Philippines Caraga Cantilan ✔

Philippines Bicol Camalig ✔

Philippines Caraga Cagwait ✔

Philippines Cagayan Valley Cabatuan ✔

Philippines Cagayan Valley ✔

Philippines Cagayan Valley Burgos ✔

Philippines Bicol Bulusan ✔

Philippines Bicol Bulan ✔

Philippines Caraga Bislig ✔

Philippines Cagayan Valley ✔

Philippines Caraga Bayabas ✔

Philippines Bicol Batuan ✔

Philippines Bicol Bato ✔

Philippines Caraga Barobo ✔ Public Disclosure Copy Philippines Bicol Barcelona ✔

Page 6 of 13 The World Bank Report No: ISR10749

Philippines Bicol Baras ✔

Philippines Bicol Balud ✔

Philippines Bicol Baleno ✔

Philippines Bicol Bagamanoc ✔

Philippines Bicol Bacacay ✔

Philippines Cagayan Valley Aurora ✔

Philippines Bicol Aroroy ✔ Public Disclosure Copy Philippines Cagayan Valley ✔

Philippines Cordillera Administrative Region Lagawe River ✔

Results

Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of births delivered in a health Percentage Value 23.00 83.00 80.00 facility in each project LGU Date 31-Dec-2004 31-May-2013 30-Jun-2013 Comments Average of first two project Average of all five project Provincial average exceeded sites (Sorsogon and Surigao sites the end of project target del Sur) Data as of December 31, 2012 % in Masbate Percentage Value 18.00 75.00 80.00 Sub Type Date 31-Dec-2008 31-May-2013 30-Jun-2013 Breakdown Comments Data as of December 31, Province did not achieve the 2012 end of project target % in Catanduanes Percentage Value 35.00 84.00 80.00 Sub Type Date 31-Dec-2008 31-May-2013 30-Jun-2013 Breakdown Comments Data as of December 31, Province achieved the end of 2012 project target % in Albay Percentage Value 28.00 84.00 80.00 Sub Type Date 31-Dec-2008 31-May-2013 30-Jun-2013 Breakdown Comments Data as of December 31, Province achieved the end of

Public Disclosure Copy 2012 project target % in Sorsogon Percentage Value 28.00 92.00 80.00

Page 7 of 13 The World Bank Report No: ISR10749

Sub Type Date 31-Dec-2004 31-May-2013 30-Jun-2013 Breakdown Comments Data as of December 31, Province greatly exceeded 2012 the end of project target % in Surigao del Sur Percentage Value 18.00 82.00 80.00 Sub Type Date 31-Dec-2004 31-May-2013 30-Jun-2013 Breakdown Comments Data as of December 31, Province achieved the end of 2012 project target Percentage of deliveries in BEmONCs in each Percentage Value 57.00 27.00 40.00 project LGU is financed by PhilHealth Date 31-Dec-2008 31-May-2013 30-Jun-2013 Sponsored Program Comments average of first two project Average of five project sites The average of the five (5)

Public Disclosure Copy sites (Surigao and Sorsogon) Data as of December 31, provinces did not meet the 2012 end of project target % in Masbate Percentage Value 13.00 0.00 40.00 Sub Type Date 31-Dec-2009 31-May-2012 30-Jun-2013 Breakdown Comments No data available % in Catanduanes Percentage Value 32.00 40.00 Sub Type Date 31-May-2013 Breakdown Comments Data as of December 31, Province did not achieve the 2012 end of project target % in Albay Percentage Value 24.00 40.00 Sub Type Date 31-May-2013 30-Jun-2013 Breakdown Comments Data as of December 31, Province did not achieve the 2012 end of project target % in Surigao del Sur Percentage Value 50.00 39.00 40.00 Sub Type Date 31-Dec-2008 31-May-2013 30-Jun-2013 Breakdown Comments Data as of December 31, Province did not achieve the 2012 end of project target % in Sorsogon Percentage Value 64.00 11.00 40.00 Sub Type Date 31-Dec-2008 31-May-2013 30-Jun-2013 Breakdown Comments Data as of December 31, Province did not achieve the 2012 end of project target Increase in CPR in each project LGU by 10 Text Value 45% 37.00 Increased by 10% percentage points Date 31-Dec-2005 31-May-2013 30-Jun-2013 Comments average of Sorsogon and average of all five project sites Did not attain end of project Surigao. But number may be Data as of December 31, target

Public Disclosure Copy an over-estimate as it 2012 Sorsogon only covered pills

Page 8 of 13 The World Bank Report No: ISR10749

% in Catanduanes Text Value 32% 46% 42% Sub Type Date 31-Dec-2008 31-May-2012 30-Jun-2013 Breakdown Comments Data as of December 31, End of project target achieved 2012 % in Masbate Text Value 22% 29% 32% Sub Type Date 31-Dec-2008 31-May-2013 30-Jun-2013 Breakdown Comments Data as of December 31, Did not attain end of project 2012 target % in Albay Text Value 33% 31% 43% Sub Type Date 31-Dec-2008 31-May-2013 30-Jun-2013 Public Disclosure Copy Breakdown Comments Data as of December 31, Did not attain end of project 2012 target % in Surigao del Sur Text Value 37% 48% 47% Sub Type Date 31-Dec-2005 31-May-2013 30-Jun-2013 Breakdown Comments Data as of December 31, End of project target achieved 2012 % in Sorsogon Text Value 29% 29% 39% Sub Type Date 31-Dec-2007 31-May-2012 30-Jun-2013 Breakdown Comments Data as of December 31, Did not attain end of project 2012 target Inclusion of WHSM standards in the Sentrong Text Value WHSM standards not Administrative Order 29 s. WHSM standards included in Sigla accreditation criteria included in the Sentrong Sigla 2008: Implementing Health the Sentrong Sigla accreditation criteria Reforms for Rapid Reduction accreditation criteria of Maternal and Neonatal Mortality Date 31-Dec-2005 31-May-2013 30-Jun-2013 Comments WHSM standards End of project target achieved incorporated in the AO (dated Sept. 9, 2008) delineating the MNCHN strategy. Sentrong Sigla accreditation standards were subsumed under PhilHealth's Maternity Care Package hralth facility accreditation criteria which follows the MNCHN guidelines Public Disclosure Copy Intermediate Results Indicators

Page 9 of 13 The World Bank Report No: ISR10749

Indicator Name Core Unit of Measure Baseline Current End Target Percentage of BEmONCs in each project LGU Percentage Value 59.00 70.00 100.00 that are PhilHealth accredited for its maternal Date 31-Dec-2008 31-May-2013 30-Jun-2013 care package Comments average of first two project Average of all five project End of project target not sites (Surigao and Sorsogon) sites achieved Data as of December 31, 2012 % in Sorsogon Percentage Value 30.00 88.00 100.00 Sub Type Date 31-Dec-2009 31-May-2013 30-Jun-2013 Breakdown Comments 5 of 17 15 of 17 Short by 2 facilities

Public Disclosure Copy Data as of December 31, 2012 % in Surigao del Sur Percentage Value 12.00 41.00 100.00 Sub Type Date 31-Dec-2009 31-May-2013 30-Jun-2013 Breakdown Comments 2 of 17 7 of 17 Short by 10 facilities Data as of December 31, 2012 % in Albay Percentage Value 6.00 72.00 100.00 Sub Type Date 31-Dec-2009 31-May-2013 30-Jun-2013 Breakdown Comments 1 of 18 13 of 18 Short by 5 facilities Data as of December 31, 2012 % in Catanduanes Percentage Value 20.00 60.00 100.00 Sub Type Date 31-Dec-2009 31-May-2013 30-Jun-2013 Breakdown Comments 2 of 10 6 of 10 Short by 4 facilities Data as of December 31, 2012 % in Masbate Percentage Value 5.00 81.00 100.00 Sub Type Date 31-Dec-2009 31-May-2013 30-Jun-2013 Breakdown Comments 1 of 21 17 of 21 Short by 4 facilites Data as of December 31, 2012 Percentage reduction in the number of normal Percentage Value 0.00 0.00 50.00 spontaneous deliveries in CEmONCs (referral Date 31-Dec-2008 31-May-2013 30-Jun-2013 facility for complicated cases) Comments Data not yet submitted Data not yet submitted Percentage of women who delivered in the Percentage Value 75.00 86.00 80.00 Public Disclosure Copy past six months had birth plans Date 31-Dec-2009 31-May-2013 30-Jun-2013

Page 10 of 13 The World Bank Report No: ISR10749

Comments Average of 5 project sites. Average of 5 project sites. End of project target achieved Data as of December 31, 2012 Percentage of FP users and ante-natal clients Percentage Value 0.00 0.00 100.00 screened for STI according to prescribed Date 31-Dec-2008 31-May-2013 30-Jun-2013 protocol Comments Data not yet submitted Data not yet submitted Percentage of women who know the 3 ways of Percentage Value 0.00 0.00 70.00 preventing the sexual transmission of HIV Date 31-Dec-2008 31-May-2013 30-Jun-2013 Comments Data not yet submitted Data not yet submitted Percentage increase from baseline of total Percentage Value 10.50 9.20 16.00 Public Disclosure Copy proportion of women or their partners using Date 01-Jan-2003 31-May-2013 30-Jun-2013 permanent methods Comments 10.5% for BTL 9.2% for BTL Increase from the baseline 0.1% for NSV Male sterilization data not End of project target not (National level, Source: 2003 collected in the 2008 NDHS attained NDHS) (National level, Source: 2008 NDHS) Percentage of project LGUs have passed an Percentage Value 38.00 60.00 100.00 ordinance on contraceptive self-reliance Date 31-Dec-2009 31-May-2013 30-Jun-2013 Comments Average of all five project Average of all five project End of project target not sites sites achieved Data as of December 31, 2012 Percentage of non-poor FP clients paying for Percentage Value 0.00 17.30 70.00 contraceptives Date 31-Dec-2008 31-May-2013 30-Jun-2013 Comments Data not yet submitted Partial data from Surigao del Sur, Albay and Catanduanes provinces Percentage of project LGUs sustaining their Percentage Value 49.00 86.00 75.00 PhilHealth Sponsored Program coverage to at Date 31-Dec-2008 31-May-2013 30-Jun-2013 least 75% of the city and municipal targets Comments Average of first two project Average in five project LGUs End of project target achieved sites (Surigao and Sorsogon) Data as of December 31, 2012 % in batch 2 provinces (Masbate, Albay and Percentage Value 100.00 75.00 Catanduanes) Sub Type Supplemental Public Disclosure Copy

Page 11 of 13 The World Bank Report No: ISR10749

Percentage of BEmONCs share their MC Percentage Value 0.00 0.00 100.00 revenues with WHT according to guidelines Date 31-Dec-2008 31-May-2013 30-Jun-2013 Comments Data not yet submitted Data not yet submitted First edition of WHSM service guidelines for Text Value Only in 5 project LGUs All LGUs nationwide Project LGUs implementing LGUs and local WHSM teams disseminated implementing the WHSM the WHSM service model and used by LGU managers and WHSM teams service model Date 31-Dec-2008 31-May-2013 30-Jun-2013 Comments WHSM service guidelines End of project target achieved incorporated in AO 2008-0029 and greatly surpased and MNCHN guidelines which are being implemented by all Public Disclosure Copy LGUs nationwide Health personnel receiving training (number) Number Value 0.00 169.00 169.00 Date 31-Dec-2008 31-Dec-2012 30-Jun-2013 Comments Project indicator is worded as 100% of BEmONC teams 100% of BEmONC teams Percentage of BEmONC trained (reported number trained teams in project LGUs trained above is number of teams and not individuals) Percentage of LGUs in project sites use Percentage Value 0.00 100.00 100.00 routinely collected WHSMP M&E data Date 28-Dec-2005 31-May-2013 30-Jun-2013 (including maternal death reviews) in their annual plans Comments Effectiveness date All LGUs participate in the End of project target achieved Rapid Results Approach (100 days) exercise that is done quarterly Selected innovative elements of project Text Value No research on OFW, FLSW, No research done on OFW, Operations research on OFW, documented and impact measured with results ARH FLSW, ARH FLSW and ARH used for scaling up Date 31-May-2013 30-Jun-2013 Comments Operations research/Special No operations research on Operations research Studies (OFW, FLSW, ARH) identified areas undertaken undertaken on OFW, FLSW identified and ARH

Data on Financial Performance (as of 24-May-2013)

Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P079628 IBRD-72900 Effective 21-Apr-2005 30-Jun-2005 28-Dec-2005 30-Jun-2012 30-Jun-2013

Disbursements (in Millions) Public Disclosure Copy Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed

Page 12 of 13 The World Bank Report No: ISR10749

P079628 IBRD-72900 Effective USD 16.00 16.00 0.00 8.94 7.06 56.00

Disbursement Graph Public Disclosure Copy

Key Decisions Regarding Implementation The Department of Health (DOH) will finalize procurement eligibilities and together with DBM determine the amount of performance-based grants (PBGs) eligible for loan financing by the project closing date. The DOH will submit the corresponding documentation to the Bank.

Restructuring History Level two Approved on 16-Aug-2010

Related Projects There are no related projects. Public Disclosure Copy

Page 13 of 13