Public Disclosure Authorized SOUTH ASIA Pakistan Health, Nutrition & Population Global Practice IBRD/IDA Investment Project Financing FY 2017 Seq No: 3 ARCHIVED on 01-Oct-2018 ISR33776 Implementing Agencies: Government of Sindh, Planning and Development, Government of Pakistan, Economic Affairs Division Public Disclosure Authorized Public Disclosure Authorized Key Dates Key Project Dates Bank Approval Date: 26-May-2017 Effectiveness Date: 04-Oct-2017 Planned Mid Term Review Date: 18-Nov-2019 Actual Mid-Term Review Date: -- Original Closing Date: 31-Dec-2021 pdotable Project Development Objectives Project Development Objective (from Project Appraisal Document) Revised Closing Date: 31-Dec-2021 The Project Development Objective (PDO) is to contribute to the reduction of the stunting rate among children under 5 years of age by targeting the most affected districts in the Province of Sindh. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1 : Expanding Access to a Multi-sectoral Package of Services for Reducing Stunting:(Cost $45.00 M) Component 2: Strengthening Key Cross-cutting Nutrition-related Interventions and Project Management:(Cost $16.62 M) Overall Ratings Public Disclosure Authorized Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The Sindh Enhancing Response to Reduce Stunting Project, financed by a US$61.62 million equivalent IDA Credit for Sindh province, was approved by the Bank's Board of Executive Directors on May 26, 2017 and declared effective on October 4, 2017. An implementation support mission was held in May 2018 to review and assess implementation progress since effectiveness, including progress towards achieving the first year s disbursement linked indicators (DLIs), and implementation of the Government of Sindh (GoS) Accelerated Action Plan (AAP) for the Reduction of Stunting and Malnutrition. Although progress has been made in achieving first year DLI targets, implementation has been slower than expected due to bureaucratic delays and implementation bottlenecks. Resolution of these challenges will require close oversight and guidance of the Stunting Task Force Secretariat (STFS) so that the pace of interventions can be expedited and AAP goals achieved. 10/1/2018 Page 1 of 9
IN00575837 IN00575839 Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Sustainability Moderate Moderate Moderate Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes contribute to reduction of stunting rate among children under 5 by targeting most affected districts Stunting prevalence (moderate/severe) (Percentage, Custom) Value 48.00 -- 48.00 43.00 Date 31-Dec-2014 -- 30-Jun-2018 31-Dec-2021 Comments: Percentage of children under age 5 who fall below minus two standard deviations (moderate and severe). Baseline information is based on the results of the Multi-indicator Cluster Survey (MICS) of 2014. Minimum acceptable diet (Percentage, Custom) Value 8.90 -- 8.90 20.00 Date 31-Dec-2014 -- 30-Jun-2018 31-Dec-2021 10/1/2018 Page 2 of 9
IN00575858 IN00630849 IN00630856 IN00630850 IN00575840 IN00630857 Comments: Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid or soft foods the minimum number of times or more during the previous day. Baseline information is based on the results of the Multi-indicator Cluster Survey (MICS) of 2014. Micro-nutrient sachet distribution (Number, Custom) Value 0.00 -- 0.00 2,650,000.00 Comments: Among children aged 6-24 months, the cumulative number who receive yearly a minimum of 90 micronutrient sprinkles sachets for three months in intervention areas Intermediate Results Indicators by Components Component 1 : Expanding Access to a Multi-sectoral Package of Services for Reducing Stunting Prenatal care visits at community level (Number, Custom) Value 0.00 -- 650,023.00 1,950,000.00 Iron supplementation among PLW (Number, Custom) Value 0.00 -- 273,015.00 1,850,000.00 TT2 at primary and secondary health services (Number, Custom) Value 0.00 -- 496,767.00 1,100,000.00 Date 30-Dec-2016 -- 30-Jun-2018 31-Dec-2020 Users of Modern Contraceptive Methods (Number, Custom) Value 0.00 -- 2,539,837.00 12,000,000.00 MUAC screening at community level (Number, Custom) 10/1/2018 Page 3 of 9
IN00575851 IN00630858 IN00630859 IN00630808 IN00575855 IN00575849 Value 0.00 -- 691,853.00 7,950,000.00 Cumulative number of villages certified ODF (Number, Custom) Value 0.00 -- 0.00 8,600.00 Cumulative number of kitchen gardens established (Number, Custom) Value 0.00 -- 90.00 2,600.00 Cumulative number of households establishing backyard poultry raising and goat farming (Number, Custom) Value 0.00 -- 460.00 26,000.00 Cumulative number of community fish ponds established (Number, Custom) Value 0.00 -- 40.00 2,600.00 Cumulative number of children (36-59 months) attending Early Childhood Education (Number, Custom) Value 0.00 -- 0.00 3,500,000.00 Number of Mothers' Groups established (Number, Custom) Value 0.00 -- 0.00 3,900.00 IN00630863 Pregnant/lactating women, adolescent girls and/or children under age 5 reached by basic nutrition services (Number, Custom) 10/1/2018 Page 4 of 9
IN00633560 IN00630864 IN00575852 IN00630838 IN00633566 Value 0.00 -- 0.00 7,950,000.00 People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Value 0.00 -- 0.00 7,950,000.00 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Value 0.00 -- 0.00 7,950,000.00 Children between age of 6-59 months receiving Vitamin A supplementation (Number, Custom) Value 0.00 -- 0.00 7,950,000.00 Component 2: Strengthening Key Cross-cutting Nutrition-related Interventions and Project Management Provincial Nutrition Steering Committee functioning (Number, Custom) Value 0.00 -- 1.00 20.00 IN00575856 Implementation of a system to strengthen coordination, collaboration and feedback between the AAP service providers and target beneficiary populations (Yes/No, Custom) Disbursement Linked Indicators DLI 1 Cumulative number of pregnant women who received 4 prenatal care and counseling visits at community level (Number, Output, 7,000,000.00, 0.00%) 10/1/2018 Page 5 of 9
IN00630832 IN00630839 IN00630840 IN00631555 Value 0.00 -- 650,023.00 1,525,000.00 DLI 2 Cumulative number of women who received 4 ANC at primary and secondary health care facilities (BHU, THQ and DHQ) (Number, Intermediate Outcome, 7,000,000.00, 0.00%) Value 0.00 -- 0.00 1,000,000.00 DLI 3 Cumulative number of children 6-59 mos who are screened (MUAC) for malnutrition at community level (Number, Intermediate Outcome, 7,000,000.00, 0.00%) Value 0.00 -- 691,853.00 5,280,000.00 DLI 4 Cumulative number of malnourished children aged 6-59 months who are registered in Outpatient Therapeutic Program centers at health facilities and mobile health clinics (Number, Intermediate Outcome, 7,000,000.00, 0.00%) Value 0.00 -- 139,136.00 320,000.00 DLI 5 Cumulative number of villages certified open defecation free (Number, Intermediate Outcome, 6,500,000.00, 0.00%) Value 0.00 -- 0.00 8,600.00 DLI 5.1 Number of signed NGO contracts (Number, Output, 1,500,000.00, 0.00%) Value 0.00 -- 2.00 10.00 Date -- -- 31-Jul-2018 -- DLI 5.2 Cumulative number of villages certified open defecation free (ODF) (Number, Intermediate Outcome, 5,000,000.00, 0.00%) 10/1/2018 Page 6 of 9
IN00630835 IN00630845 IN00630851 Value 0.00 -- 0.00 8,600.00 DLI 6 Introduction of nutrition and life skills curriculum/instructional materials in Grades 6-10 (Yes/No, Process, 2,000,000.00, 0.00%) DLI 7 Implementation of a province-wide, multi-sectoral media/communications campaign (Yes/No, Intermediate Outcome, 2,000,000.00, 0.00%) DLI 7.1 Adoption of BCC plan (Yes/No, Process, 500,000.00, 0.00%) DLI 7.2 Launch of campaign (Yes/No, Process, 1,500,000.00, 0.00%) DLI 8 Percentage of allocation nutrition financiing actually expended (Text, Output, 6,500,000.00, 0.00%) Value 0.00 -- 0.00 Amount of nutrition related releases for AAP by June 30 (PKR). Disbursements will initially focus on the total amount of AAP allocation (1 billion PKR) and the proportion released to the priority districts. Once the nutrition expenditure 10/1/2018 Page 7 of 9
DLI 8.1 Amount of nutrition related releases for AAP by June 30 (PKR) (Text, Output, 2,000,000.00, 0.00%) tracking system is established, disbursements will be based on the annual amount of nutrition-related AAP expenditures Value 0.00 -- 1,500,000,000.00 PKR DLI 8.2 Establishment of nutrition expenditure tracking system (Text, Process, 1,500,000.00, 0.00%) Amount of nutrition related releases for AAP by June 30 (PKR). Disbursements will initially focus on the total amount of AAP allocation (1 billion PKR) and the proportion released to the priority districts. Once the nutrition expenditure tracking system is established, disbursements will be based on the annual amount of nutrition-related AAP expenditures. Value not established -- not established system functional Date -- -- 16-May-2018 -- DLI 8.3 Annual amount of nutrition-related expenditures by AAP sector (Text, Output, 3,000,000.00, 0.00%) Value 0.00 -- 1,162,000,000.00 Annual amount to be calculated after the nutrition expenditure tracking system is functional. Data on Financial Performance 10/1/2018 Page 8 of 9
Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P161624 IDA-60470 Effective USD 61.62 61.62 0.00 4.95 59.85 7.6% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P161624 IDA-60470 Effective 26-May-2017 26-Jul-2017 04-Oct-2017 31-Dec-2021 31-Dec-2021 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 10/1/2018 Page 9 of 9