PERU Juntos Results for Nutrition Project Report No. 135232 JUNE 7, 2019 © 2019 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 accuracy of the data included in this work. The Any queries on rights and licenses, including World Bank. 2019. 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Report No.: 135232 PROJECT PERFORMANCE ASSESSMENT REPORT PERU JUNTOS RESULTS FOR NUTRITION PROJECT (IBRD LOAN NO. 79610) June 7, 2019 Human Development and Economic Management Independent Evaluation Group Currency Equivalents (annual averages) Currency Unit = nuevo sol (S/.) 2009 $1.00 S/. 3.01 2014 $1.00 S/. 3.18 2010 $1.00 S/. 2.82 2015 $1.00 S/. 3.37 2011 $1.00 S/. 2.75 2016 $1.00 S/. 3.37 2012 $1.00 S/. 2.63 2017 $1.00 S/. 3.26 2013 $1.00 S/. 2.70 Abbreviations CCT conditional cash transfer CRED Control of Growth and Development for Infants and Children in Peru (Control de Crecimiento y Desarrollo) ENCRED Encuesta a Establecimientos de Salud (Health Centers Survey) IBRD International Bank for Reconstruction and Development ICR Implementation Completion and Results Report IEG Independent Evaluation Group MEF Ministry of Economy and Finance (Ministerio de Economía y Finanzas) MIDIS Ministry for Development and Social Inclusion (Ministerio de Desarrollo e Inclusión Social) MINSA Ministry of Health (Ministerio de Salud) PAN National Nutrition Program (Programa Articulado de Nutrición) PPAR Project Performance Assessment Report RENIEC National Civil Registry (Registro Nacional de Identidad y Estado Civil) SIGA Integrated Administrative Management System (Sistema Integrado de Gestión Administrativa) SIS Integral Health Insurance Program (Seguro Integral de Salud) SWAp sectorwide approach All dollar amounts are US dollars unless otherwise indicated. Fiscal Year Government: January 1–December 31 Director-General, Independent Evaluation Ms. Alison Evans Acting Director, Human Development and Economic Management Ms. Sophie Sirtaine Acting Manager, Corporate and Human Development Mr. Rasmus Heltberg Task Manager Ms. Ann Elizabeth Flanagan ii Contents Preface .............................................................................................................................................................. viii Summary .............................................................................................................................................................. x 1. Background and Context .......................................................................................................................... 1 Project Context ............................................................................................................................................. 1 2. Objectives and Design ............................................................................................................................... 5 Objectives ....................................................................................................................................................... 5 Relevance of the Objectives ..................................................................................................................... 5 Project Design ............................................................................................................................................... 7 Components ................................................................................................................................................................ 7 Theory of Change ...................................................................................................................................................... 8 3. Implementation ......................................................................................................................................... 10 Project Restructuring ................................................................................................................................ 10 Implementation Arrangements ............................................................................................................. 10 Implementation Experience ..................................................................................................................... 11 Implementation of Monitoring and Evaluation .............................................................................................. 11 Safeguards Compliance ......................................................................................................................................... 12 Financial Management and Procurement ....................................................................................................... 12 4. Achievement of the Objectives ............................................................................................................ 13 Objective 1: Increase Demand for Nutrition Services by Strengthening the Operational Effectiveness of Juntos ............................................................................................................................. 14 Outputs and Intermediate Outcomes ............................................................................................................... 14 Did Demand for Nutrition Services Increase? ................................................................................................ 15 Objective 2: Improve Coverage of the Basic Preventive Health and Nutrition Services In Communities Covered under PAN Including Juntos ...................................................................... 19 Outputs and Intermediate Outcomes ............................................................................................................... 19 Did Coverage of Basic Preventive Health and Nutrition Services Improve?....................................... 20 Objective 3: Improve the Quality of Basic Preventive Health and Nutrition Services in Communities Covered under PAN Including Juntos ...................................................................... 21 Outputs and Intermediate Outcomes ............................................................................................................... 21 Did the Quality of Basic Preventive Health and Nutrition Services Improve? .................................... 22 Why Did Malnutrition Decline? ............................................................................................................ 23 iii 5. Efficiency ...................................................................................................................................................... 24 6. Ratings .......................................................................................................................................................... 27 Outcome ...................................................................................................................................................... 27 Risk to Development Outcome ............................................................................................................ 27 Bank Performance .................................................................................................................................... 28 Quality at Entry ........................................................................................................................................................ 28 Quality of Supervision ........................................................................................................................................... 29 Monitoring and Evaluation .................................................................................................................... 30 Design ......................................................................................................................................................................... 30 Implementation ....................................................................................................................................................... 30 Use................................................................................................................................................................................. 31 Lessons .........................................................................................................................................................