GA Schedule 2, Section IV.B.1(b)&(c) The DoH shall recruit and maintain a qualified financial management specialist and a procurement specialist. Condition of disbursement for Category (1) and (2) GA Schedule 2, Section IV.B.1(c) & PA Schedule Section I.E.1&2 The DoH shall prepare a ESMP, in accordance with the ESSAF requirements; and hire a construction engineer to assist the HSRU in implementing the project Condition of disbursement for Category (2) PA Schedule Section I.C The DoH shall establish and maintain a Grievance Redressal Mechanism satisfactory to the Bank in all Project districts. 45 days after the signing (Effective Date) of the Grant Agreement (thereafter recurrent) PA Schedule Section I.A.1(a) The DoH shall establish and maintain a Project Steering Committee with participation of representatives of the selected districts. . One month after effective date (thereafter recurrent) PA Schedule Section I.A.1(b) The DoH shall maintain the HSRU for the daily management and coordination of the Project Recurrent PA Schedule Section I.A.1(d) The DoH shall maintain Executive District Officers (Health) in each Selected District to oversee contractors, monitor progress of civil works, and serve as the second tier decision maker under the Grievance Mechanism. Recurrent PA Schedule Section I.A.3 The DoH shall hire and maintain monitoring and evaluation experts to establish data-base at district level, carry out validation activities and baseline, mid-term and end-line surveys. Three months after the effective date (thereafter recurrent) PA Schedule Section I.A.1(c) DoH shall establish, operationalize and maintain, in each selected district, a District Health Management Team (DHMT), responsible for reviewing, monitoring and evaluating project implementation at district level. One month after the effective date (thereafter recurrent) specific
PA Schedule Section I.B.4 The DoH shall undertake to regularly allocate and promptly transfer (as a lump sum and a single line item) to the contractors selected for the outsourced management of the health facilities, the necessary funds for operation and maintenance of the respective health facilities and the payments of staff salaries for the following quarter, as well as the full authority for any reallocations required. Recurrent (30 days after the beginning of each calendar quarter, commencing in the first quarter of FY2012/13) PA Schedule Section I.B.3 The DoH shall prepare annual work plans each year and implement the Project accordingly Recurrent (by August 15 of each year) PA Schedule Section I.E.3 No land taking shall be carried out under the Project. Any purchase of land shall be done on a willing buyer- willing seller basis. The Grant shall not be utilized for any such purchase. Recurrent PA Schedule Section I.E.4 DoH shall ensure that the contractors awarded management responsibilities over health facilities comply with the Standard Operating Procedures for the Handling and Disposal for Medical Wastes to be included in the Operations Manual Recurrent PA Schedule Section I.E.5 DoH shall vest the Executive District Officers (Health) with powers and responsibilities to ensure the contractors’ compliance with the ESMP and the and other obligations under their respective contracts Recurrent PA Schedule Section II.B.4 The DoH, in coordination with PIFRA Directorate, shall prepare and t implement an action plan for the incorporation of the project accounts to the financial accounting and budgeting systems established under the PIFRA Project. Six month after effective date (thereafter recurrent)
Annex 2: Results Framework and Monitoring : akhtunkhwa Project Project Development Objective (PDO): To improve the availability, accessibility and delivery of primary and secondary healthcare services at the district level PDO Level Results Indicators* Core Unit of Measure Baseline Cumulative Target Values** Frequency Data Source/ Methodology Responsibility for Data Collection Description (indicator definition etc.) YR 1 YR 2 YR3 Indicator 1: People with access to a defined package of health, nutrition, and reproductive health services % and # TBD (1st year of implementation) 50 75 90 Annually DHIS, Project progress monitoring reports DoH “Package”: As defined in the provincial Standards manuals for PHC and hospital. Numerator: # of beneficiary population residing in the catchment areas of health facilities hubs providing the defined package of agreed services Indicator 2: Percent of children with Severe Acute Malnutrition provided adequate nutrition services % TBD (1st year of implementation 10 25 50 Quarterly DHIS, Project progress monitoring reports DoH Numerator: # of children provided services at health facilities’ for SAM; Denominator: # of children identified as malnourished by community workers/ screening Indicator 3: Percent of births attended by skilled health personnel % and # 5 percentage points increase over baseline 10 percentage points increase over baseline 15 percentage points increase over baseline Annually DHIS and Surveys DoH Skilled Birth Attendants= Doctors, nurses, LHVs and midwives. Numerator births by SBA/ Denominator= total births in catchment area Indicator 4: Contraceptive prevalence rate (any modern % 5 percentage points Annually DHIS and Surveys DoH
method) increase over baseline Indicator 5: Community satisfaction with health care services delivery by public sector % and # 5 percentage points increase over baseline 10 percentage points increase over baseline 15 percentage points increase over baseline Annually Exit Interviews and Surveys DoH % of population satisfied out of total population residing in catchment INTERMEDIATE RESULTS Intermediate Result - Component 1: Increased utilization and coverage of primary health care services and secondary care services in the selected districts Indicator 1: Number of districts contracted out for management of services Number 0 6 6 6 Annually Project progress monitoring reports DoH Annual review of contract extensions Indicator 2: Percentage of ‘Hubs’ established and assessed as fully functioning by DoH % 0 50% 100% 100% Annually Project progress monitoring reports DoH Appropriate groups of facilities identified as hubs and hubs are staffed, providing services and reporting Numerator: total number of hubs established/ Denominator= total number of hubs agreed in the service delivery contracts Indicator 3: Training needs assessment and strategy for the district completed within six months from the contract date, % of trainings conducted according to plan Text, % 0 25% 75% 100% Quarterly Project progress monitoring reports DoH # of care providers trained out of total care providers according to plan based on assessment Indicator 4: Health Facility Utilization Rate: Visits per person per year. # 1.0 Annually DHIS & Project progress monitoring reports DoH # of OPD seen at HF/ Total population in catchment area disaggregated by sex Intermediate Result - Component 2:
Adequately equipped and functional health infrastructure available in the selected districts Indicator 1: Health facilities reconstructed, renovated, and/or equipped (number) # ? Annually Project progress monitoring reports DoH Indicator 2: # of DHQ hospitals refurbished # 0 1 2 3 Annually Project progress monitoring reports DoH Indicator 3: Health facilities adequately refurbished % and # 0 25% 75% 100% “Adequately” = functioning toilet, waiting area for patients, whitewashed and clean facilities Intermediate Result - Component 3: Improved supervision and timely utilization of allocated resources through key management decisions based on evidence Indicator 1: Timely disbursement of funds to a consultant/NGO implementing contracting out % 90% 90% 90% Quarterly Project progress monitoring reports DoH “Timely”: Funds released within 30 days of receipt of invoice Indicator 2: Biannual meetings held for Provincial Steering Committee # 2 2 2 Annually Project progress monitoring reports DoH 1st meeting held within one month from the project effectiveness Indicator 3: Number of Health facilities submitting monthly reports on time to district # 50% 90% 90% Quarterly DHIS DoH Numerator: # of reports received. Denominator: # of reports expected per month Indicator 4: Establishment within two months from the contract date and operationalization of District Health Management Team % 100% Annually Project progress monitoring reports DoH “Operationalized”: Documented meetings have occurred at least once every two months prior to the end of each FY
Annex 3: Summary of Estimated Project Costs PAKISTAN: akhtunkhwa Project (US$ million) Component MDTF (Bank) %age GoKP %age Component 1: Improve accessibility and quality of healthcare services at the district level through outsourcing of management 11.0 20% 45.0 80% Component 2: Rehabilitation of the Health infrastructure in the districts 1.0 100% 0.0 0% Component 3: Establish and operationalise a robust monitoring and evaluation system in each district and provincial level 4.0 100% 0.0 0% Total 16.00 18% 45.0 82%