Peru Second Phase of Health Reform Program Implementation Completion and Results Report

E. Bank Staff
Positions	At ICR	At Approval
Vice President:	Jorge Familiar	Pamela Cox
Country Director:	Alberto Rodriguez	Carlos Felipe Jaramillo
Practice Manager:	Daniel Dulitzky	Keith E. Hansen
Project Team Leader:	Andre C. Medici	Fernando Lavadenz
ICR Team Leader:	Federica Secci
ICR Primary Author:	Federica Secci

F. Results Framework Analysis
Project Development Objectives (from Project Appraisal Document)

Framed within the long-term objective of the Health Reform Program (APL in all its phases) to reduce maternal and infant mortality rates in Peru’s nine poorest regions of the country (Amazonas, Huánuco, Huancavelica, Ayacucho, Apurimac, Cusco, Cajamarca, Ucayali, and Puno); the specific APL 2 Project Development Objectives are to: (i) improve family care practices for women (during pregnancy, delivery and breast-feeding), and children under the age of three; (ii) strengthen health services networks with capacity to solve obstetric, neonatal and infant emergencies and to provide comprehensive health services to women (during pregnancy, delivery and breast-feeding) and children under the age of three; and (iii) support MINSA's governance functions of regulation, quality, efficiency and equity for improving the new health delivery model of maternal and child health care in a decentralized environment (same as in the Loan Agreement).

Revised Project Development Objectives (as approved by original approving authority)

The PDOs, the Key Performance Indicators (KPIs) and the outcome targets were not revised. However, some targets were revised during the 2014 project restructuring for the Intermediate Outcome Indicators (IOIs) (see below).

(a) PDO Indicator(s) Achievement of targets was assessed as follows: Target Surpassed: the value of the indicator at the end of the project (December 2015, based on 2014 data) is higher than the target Target Achieved: the value of the indicator at the end of the project (December 2015, based on 2014 data) is equal to the target, or it is equal to or greater than 85% of the target Target Partially achieved: the value of the indicator at the end of the project (December 2015, based on 2014 data) is equal to or greater than 65% and lower than 85% of the target Target Not Achieved: the value of the indicator at the end of the project (December 2015, based on 2014 data) is equal to or lower than 64% of the target Not evaluated: no data is available to assess the achievement of the target and/or the value of the indicator.
Indicator		Baseline Value	Original Target Values (from approval documents)		Formally Revised Target Values			Actual Value Achieved at Completion or Target Years
Overall program indicator: Reduce infant mortality rate
Value:		42	25					17
Date:		2005	January 2015 (2013 data)					December 2015 (2014 data)
Comments: Target Surpassed
Overall program indicator: Reduce chronic malnutrition of children under the age of 5
Value:		38.2	30.2					23.7%
Date:		2005	January 2015 (2013 data)					December 2015 (2014 data)
Comments: Target Surpassed
KPI #1: Increase the proportion of institutional deliveries in rural areas of the nine selected Regions from 44% (2005) to 78% (2013) – proxy indicator for Maternal Mortality
Value:		44%	78%					74.2%
Date:		2005	January 2015 (2013 data)					December 2015 (2014 data)
Comments: Target Achieved (89%).
KPI #2: Reduce the prevalence of anemia among children under age in the nine regions from 69.5% (2005) to 60% (2013)
Value:		69.5%	60%					57.3%
Date:		2005	January 2015 (2013 data)					December 2015 (2014 data)
Comments: Target Surpassed
KPI #3: Increase from 64% to 80% the share of children in the nine selected regions who are exclusively breastfed until 6 months of age
Value:		64%	80%					87%
Date:		2005	January 2015 (2013 data)					December 2015 (2014 data)
Comments: Target Surpassed
KPI #4: Reduce the prevalence of anemia among pregnant women in the nine Regions from 41.5% (2005) to 35% (2013)
Value:		41.5%	35%					36.4%
Date:		2005	January 2015 (2013 data)					December 2015 (2014 data)
Comments: Target Partially Achieved (78%).
KPI #5: Reduce the hospital lethality rate among neonates in the nine selected Regions from 9.5% (2005) to 5% (2013)
Value:		9.5%	5%					5%
Date:		2005	January 2015 (2013 data)					December 2015 (2014 data)
Comments: Target Achieved (100%).
KPI #6: Increase in the proportion of pregnant women of the nine regions with at least 1 prenatal control during the first trimester of pregnancy from 20% (2005) to 45% (2013)
Value:		20%	45%					69.1%
Date:		2005	January 2015 (2013 data)					December 2015 (2014 data)
Comments: Target Surpassed
(b) Intermediate Outcome Indicator(s) The rating scale is the same as the one above used for the PDO Indicators.
Indicator	Baseline Value			Original Target Values (from approval documents)		Formally Revised Target Values	Actual Value Achieved at Completion or Target Years
IOI #1: Percentage of SIS affiliated children who received growth and development controls (CRED) according to their age
Value	34%			66%			56.8%
Date	2005			January 2015 (2013 data)			December 2015 (2014 data)
Comments: Target Partially Achieved (71%).
IOI #2: Percentage of health facilities with improvement in infrastructure (minor construction, rehabilitation and/or new equipment)
Value	0			104		Dropped	104
Date	2005			January 2015 (2013 data)		2014	December 2015 (2014 data)
Comments: Target Achieved (100%) (dropped at the 2014 restructuring but reintroduced for the ICR, based on government’s data).
IOI #3: Percentage of SIS affiliated rural pregnant women with laboratory tests on hemoglobin, urine and syphilis
Value	37%			80%		53.5%	69%
Date	2005			January 2015 (2013 data)		December 2015 (2014 data)	December 2015 (2014 data)
Comments: Surpassed against revised target; 74% achievement against original target.
IOI #4: Percentage of pregnant women under SIS that receive iron and folic acid supplements
Value	37%			80%		60%	55%
Date	2005			January 2015 (2013 data)		December 2015 (2014 data)	December 2015 (2014 data)
Comments: Revised Target Partially Achieved (78%); 42% achievement against original target.
IOI #5: Percentage of women satisfied with the services in selected facilities by confidence index
Value	N/A			25%		Dropped	74.4%
Date	2005			January 2015 (2013 data)		2014	December 2015 (2014 data)
Comments: Surpassed (dropped at 2014 restructuring, but reintroduced for the ICR). Based on ISR data, the target was 25% and the value after the survey was conducted was 74.4%.
IOI #6: Percentage of cesareans in SIS affiliated pregnant rural women
Value	3%			5%		10%	9.5%
Date	2005			January 2015 (2013 data)		December 2015 (2014 data)	December 2015 (2014 data)
Comments: Revised Target Achieved (93%); surpassed against original target.
IOI #7: Percentage of references among SIS-affiliated women (during pregnancy and puerperium) and neonates
Value	N/A			5%		Dropped	N/A
Date	2005			January 2015 (2013 data)		2014	December 2015 (2014 data)
Comments: Not evaluated. Indicator not monitored throughout the project and dropped at restructuring (2014)
IOI #8: Percentage of SIS affiliated households that make out-of-pocket expenditures in medicines
Value	67.3%			25%		55%	56%
Date	2005			January 2015 (2013 data)		December 2015 (2014 data)	December 2015 (2014 data)
Comments: Revised Target Achieved (92%); 27% achievement against original target.
IOI #9: Number of accredited health establishment by type of resolution
Value	80			169		Dropped	N/A
Date	2005			January 2015 (2013 data)		2014	December 2015 (2014 data)
Comments: Not evaluated. Indicator not monitored throughout the project and dropped at restructuring (2014)
IOI #10: Number of Management Agreements in place
Value	N/A			N/A		Dropped	N/A
Date	2005			January 2015 (2013 data)		2014	December 2015 (2014 data)
Comments: Not evaluated. Indicator not monitored throughout the project and dropped at restructuring (2014)
IOI #11: Number of health personnel and community health workers trained within the behavior change campaign (EPPES)
Value	0			758			1178
Date	2005			January 2015 (2013 data)			December 2015 (2014 data)
Comments: Surpassed (added for the ICR - based on Government data)
IOI #12: Number of health facilities improved
Value	0			73			69
Date	2005			January 2015 (2013 data)			December 2015 (2014 data)
Comments: Achieved (95%) (added for the ICR - based on Government data). This indicator measured the number of facilities that were either built, re-built or expanded by the project (i.e. major constructions).
IOI #13: Norms and regulations to improve efficiency and equity of the health delivery system prepared
Value	0			27			32
Date	2005			January 2015 (2013 data)			December 2015 (2014 data)
Comments: Surpassed (added for the ICR - based on Government data)
IOI #14: Clinical pathways and corresponding financing systems designed
Value	0			11			16
Date	2005			January 2015 (2013 data)			December 2015 (2014 data)
Comments: Surpassed (added for the ICR - based on Government data)
IOI #15: Periodic evaluations of the performance of the health networks prepared
Value	0			17			19
Date	2005			January 2015 (2013 data)			December 2015 (2014 data)
Comments: Surpassed (added for the ICR - based on Government data)