Document of The World Bank

Report No: ICR00003710

Public Disclosure Authorized

IMPLEMENTATION COMPLETION AND RESULTS REPORT (TF-11062)

ON A

GRANT

IN THE AMOUNT OF US$16.00 MILLION

FROM THE MULTI-DONOR TRUST FUND FOR AND

Public Disclosure Authorized FEDERALLY ADMINISTERED TRIBAL AREAS AND BALOCHISTAN

TO THE

ISLAMIC REPUBLIC OF

FOR A

REVITALIZING HEALTH SERVICES IN KHYBER PAKHTUNKHWA PROJECT

August 31, 2016

Public Disclosure Authorized

Health, Nutrition and Population Global Practice South Asia Region

Public Disclosure Authorized

CURRENCY EQUIVALENTS (Exchange Rate Effective April 12, 2016)

Currency Unit = Pakistani Rupee (PKR) US$1.00 = PKR 104.80 PKR 1.00 = US$0.01

FISCAL YEAR July 1 – June 30

ABBREVIATIONS AND ACRONYMS

ADB Asian Development Bank KP Khyber Pakhtunkhwa Province BHU Basic Health Unit M&E Monitoring and Evaluation CPR Contraceptive Prevalence Rate MDTF Multi-Donor Trust Fund CPS Country Partnership Strategy MDTF-1 Round 1 of the KP/FATA/Balochistan Multi-Donor Trust Fund DALY Disability Adjusted Life Years MICS Multi-Indicators Cluster Survey DHIS District Health Information System NPV Net Present Value DHMT District Health Management Team NGO Non-governmental Organization DoH Department of Health ORAF Operational Risk Assessment Framework EPP Emergency Project Paper PSLM Pakistan Social And Living Standards Measurement Survey ERR Economic rate of return PC-I Planning Commission Form I ESMP Environmental and Social PCNA Post-Crisis Needs Assessment Management Plan FATA Federally Administered Tribal Areas PDO Project Development Objective FCV Fragile, conflict, and violence PIFRA Project for Improvement of Financial Reporting and Auditing FM Financial Management PMU Project Management Unit GoKP Government of Khyber PPHI People’s Primary Health Care Initiative Pakhtunkhwa GoP Government of Pakistan Pakistan Social And Living Standards PSLM Measurement Survey HSRU Health Sector Reform Unit RHC Rural Health Center IO Intermediate Outcome SBA Skilled Birth Attendance ISR Implementation Status and Results TDP Temporarily Displaced Persons Report JSDF Japan Social Development Fund

Senior Global Practice Director: Timothy Grant Evans Country Director: Patchamuthu Illangovan Practice Manager: Rekha Menon Project Team Leader: Tayyeb Masud ICR Team Leader/Author: Naoko Ohno

Pakistan Revitalizing Health Services in Khyber Pakhtunkhwa Project CONTENTS

Data Sheet A. Basic Information ...... i B. Key Dates ...... i C. Ratings Summary ...... i D. Sector and Theme Codes ...... ii E. Bank Staff ...... ii F. Results Framework Analysis ...... ii G. Ratings of Project Performance in ISRs ...... vii H. Restructuring (if any) ...... vii I. Disbursement Profile ...... viii

1. Project Context, Development Objectives and Design ...... 1 2. Key Factors Affecting Implementation and Outcomes ...... 5 3. Assessment of Outcomes ...... 12 4. Assessment of Risk to Development Outcome ...... 22 5. Assessment of Bank and Borrower Performance ...... 23 6. Lessons Learned...... 26 7. Comments on Issues Raised by Grantee/Implementing Agencies/Donors...... 28

Annex 1. Project Costs and Financing ...... 29 Annex 2. Outputs by Component...... 30 Annex 3. Economic and Financial Analysis ...... 32 Annex 4. Grant Preparation and Implementation Support/Supervision Processes ...... 35 Annex 5. Beneficiary Survey Results ...... 37 Annex 6. Stakeholder Workshop Report and Results ...... 38 Annex 7. Summary of Grantee's ICR and/or Comments on Draft ICR ...... 39 Annex 8. Comments of Cofinanciers and Other Partners/Stakeholders ...... 51 Annex 9. List of Supporting Documents ...... 52 Map 53

A. Basic Information

Pakistan: Revitalizing Country: Pakistan Project Name: Health Services in KP Project ID: P126426 L/C/TF Number(s): TF-11062 ICR Dat