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

Document of
The World Bank

Report No: ICR00003691

IMPLEMENTATION COMPLETION AND RESULTS REPORT (IBRD-76430)   ON A LOAN IN THE AMOUNT OF US$15.0 MILLION TO THE REPUBLIC OF PERU FOR A SECOND PHASE OF THE HEALTH REFORM PROGRAM June 30, 2016 Health, Nutrition and Population Bolivia, Ecuador, Peru and Venezuela Country Management Unit Latin America and the Caribbean Region

CURRENCY EQUIVALENTS

(Exchange Rate Effective December 31, 2015)

Currency Unit = Peruvian Nuevo Sol

PEN 300.35 = US$ 1.00

US$ 1.00 = PEN 3.33

FISCAL YEAR

January 1 – December 31

ABBREVIATIONS AND ACRONYMS

APL Adaptable Program Loan AUS Aseguramiento Universal en Salud – Universal Health Insurance CPS Country Partnership Strategy CRED Control de Crecimiento y Desarrollo CRVS Civil Registration and Vital Statistics DIA Derecho a la Identidad y Aseguramiento DIRESA Dirección Regional de Salud EA Environmental Assessment EDA Extreme Diarrhea ENDES Encuesta Demográfica y de Salud Familiar EPPES Estrategia de Promoción de Práctica y Entornos Saludables FS Feasibility Study GOP Government of Peru IADB Inter-American Development Bank ICR Implementation Completion and Results Report IMR Infant Mortality Rate INT Department of Institutional Integrity  IOI Intermediate Outcome Indicator IPP Indigenous People Plan ISR Implementation Status and Results Report

KPI Key Performance Indicator M Million M&E Monitory and Evaluation MA Management Agreement MEF Ministerio de Economía y Finanzas – Ministry of Economy and Finance MINSA Ministerio de Salud de Perú – Ministry of Health of Peru MMR Maternal Mortality Rate PAD Project Appraisal Document PARSALUD Programa de Apoyo a la Reforma del Sector Salud PDO Project Development Objective PIU Project Implementation Unit PRONIS Programa Nacional de Inversión de Salud QUALY Quality Adjusted Life Years RF Results Framework SIAF Sistema Integrado de Administración Financiera SIS Seguro Integral de Salud – Comprehensive Health Insurance SNIP Sistema Nacional de Inversión Publica SUNASA Superintendencia Nacional de Salud

Senior Global Practice Director: Timothy G. Evans Practice Manager: Daniel Dulitzky Project Team Leader: Andre Medici ICR Team Leader/Author: Federica Secci

PERU

Second Phase of the Health Reform Program (P095563)

TABLE OF CONTENTS

Data Sheet B. Key Dates 5 C. Ratings Summary 5 D. Sector and Theme Codes 6 E. Bank Staff 6 F. Results Framework Analysis 6 G. Ratings of Project Performance in ISRs 10 H. Restructuring 11 I. Disbursement Profile 11 1. Project Context, Development Objectives and Design 13 2. Key Factors Affecting Implementation and Outcomes 17 3. Assessment of Outcomes 23 4. Assessment of Risk to Development Outcome 34 5. Assessment of Bank and Borrower Performance 35 6. Lessons Learned 38 7. Comments on Issues Raised by Borrower/Implementing Agencies/Partners 39 Annex 1. Project Costs and Financing 40 Annex 2. Outputs by Component 41 Annex 3. Economic and Financial Analysis 51 Annex 4. Bank Lending and Implementation Support/Supervision Processes 57 Annex 5. Beneficiary Survey Results 59 Annex 6. Stakeholder Workshop Report and Results 60 Annex 7. Summary of Borrower's ICR and/or Comments on Draft ICR 61 Annex 8. Comments of Cofinanciers and Other Partners/Stakeholders 83 Annex 9. List of Supporting Documents 84 Annex 10: Analysis of PDO Achievement 86 Annex 11: Loan Amount Allocation 90 Annex 12: Organization of PARSALUD II Project Implementation Unit (PIU) 92 MAP 93

Data Sheet

A. Basic Information
Country:	Peru	Project Name:	PE- (APL2) Health Reform Program
Project ID:	P095563	L/C/TF Number(s):	IBRD-76430
ICR Date:	06/30/2016	ICR Type:	Core ICR
Lending Instrument:	APL	Borrower:	GOVERNMENT OF PERU
Original Total Commitment:	USD 15.00M	Disbursed Amount:	USD 11.98M
Revised Amount:	USD 15.00M
Environmental Category: B
Implementing Agencies: PARSALUD
Cofinanciers and Other External Partners: Inter-American Development Bank (IADB)