This is the first Annual Progress Implementation Report (APIR) for the 4th Health Population Nutrition Sector Program (HPNSP) of Bangladesh, covering the implementation period FY 2017-18 (July 2017-June 2018).

1. Annual Program Implementation Report
(APIR)-2018
July 2017– June 2018
Program Management & Monitoring Unit (PMMU)
Planning Wing
Ministry of Health and Family Welfare
4th HEALTH, POPULATION AND NUTRITION SECTOR
PROGRAM (4th HPNSP)
January 2017 - June 2022
Mohammad Golam Kibria
HIS/M&E Advisor, PMMU

2. • To review implementation progress
(programmatic and financial) of the OPs of the 4th
HPNSP during FY 2017-18;
• To capture selective descriptive features of
program activities implemented by OPs during the
reporting period;
• To highlight other issues of importance for the
achievement of HNP sector goals;
• To support the IRT of Annual Program Review
(APR)-2018 by providing information on the
progress of the 4th HPNSP during FY 2017-18.
Purposes of APIR 2018

3. The APIR-2018 has been presented in three parts: PART-A, PART-B
and PART-C.
PART-A:
• Chapter-1: Methodology for the preparation of APIR-2018
• Chapter-2: Summary Report
• Financial Progress
• Update of Result Framework Indicators
• Programmatic achievements measured by OP indicators
• Progress in Training and Workshop
• Progress in improving services and strengthening systems
• Implementation challenges and recommendations
• Progress in SDGs and DLIs
Structure of APIR 2018 (I)

4. • Chapter-3: Issues of Importance
• Chapter-4 : Special note on emergency health response to
Rohingya influx
Part-B: Summary and OP-wise factsheet
Part-C: Annexures
Structure of APIR 2018 (II)

5. PART- A: Methodology (I)
Quantitative
• Customized structured data collection templates
developed for each OP
• Templates finalized in consultation with relevant LDs
through four workshops
• LDs submitted completed templates which were
checked for completeness, consistency of provided
information and accuracy
• Financial data drawn from monthly ADP review
• APIR to be finalized following incorporation of
feedback from today’s workshop

6. PART- A: Methodology (II)
Qualitative
• Analysis and presentation of issues of importance for
the overall sector through desk review including HNP
progress of SDGs and DLIs
• A special note on emergency health response to
Rohingya influx

7. Financial Progress
July 2017 – June 2018

8. Total RADP Utilization Position of 4th
HPNSP for FY 2017-18 (in crore Tk.)
Division OP
RADP Allocation Released Fund Fund Spent
%SpentoverRelease
%SpentoverAllocation
Total GOB
PA
Total GOB
PA
Total GOB
PA
Total RPA Total RPA RPA DPA
MOHFW
All
29
OPs
6034.3 3398.0 2636.3 2045.1 5919.6 3379.2 2540.4 1989.9 5588.3 3178.1 1860.8 549.4 94%
93
%
HSD
19
OPs
4841.4 2661.2 2180.2 1603.9 4769.0 2653.9 2115.2 1579.7 4571.1 2547.6 1489.0 534.5 96%
94
%
ME&FWD
10
OPs
1192.9 736.8 456.1 441.2 1150.5 725.4 425.2 410.2 1017.2 630.5 371.8 14.9 88%
85
%

9. Spending rate80%
75%
70%
90%
99%
91%
50%
99%
83%
98%
84%
94%
90%
89%
94%
96%
95%
94%
98%
93%
75%
87%
94%
68%
66%
91%
80%
93%
87%
75%
67%
59%
90%
99%
91%
35%
99%
64%
94%
84%
69%
85%
94%
96%
94%
94%
98%
93%
69%
81%
88%
68%
50%
91%
78%
93%
87%
0%
20%
40%
60%
80%
100%
SWPMM
PMR
HEF
SDAM
HIS&eH
PSSM-HS
HRD
PFD
IFM
MNCAH
NNS
CDC
TBL&ASP
NCDC
NEC
CBHC
HSM
L&HEP
AMC
PME
MIS
PSSM-FP
ME&HMD
NMES
TRD
MCRAH
CCSDP
FP-FSD
IEC
HSD ME&FWD
Spendingrate(%)
Spending rate by OPs during FY 2017-18
Expenditure against Release (%) Expenditure against Allocation (%)
Average Expenditure vs Allocation (%) Average Expenditure vs Release (%)
94%

10. Indicator Progress
July 2017– June 2018

11. Progress Measured by OP Indicators
Achieved: Equal or more than 80%; Partially Achieved: Ranges from more than 20% to less than 80%;
Not Achieved: Less than or equal to 20% ; Not available: Data was not provided by the OP;
Not Applicable: Inapplicable for this reporting period
N=131
68 Achieved,
58%
23 Partially
Achieved, 20%
8 Not Available,
7%
17 Not achieved,
15%
Note: 1 indicator from SGS, 3 indicators from SHS and 11 indicators from IHS
component were not applicable

12. Progress Measured by OP Indicators of
HSD (n=19)
0%
25%
50%
75%
100%
NEC HIS&e-HPSSM-HS HEF L&HEP SDAM TBL&ASP CDC NNS PFD HRD MNCAH SWPMM PMR HSM CBHC AMC NCDC IFM
Achieved Partially Achieved Not Achieved Not Available

13. Progress Measured by OP Indicators of
ME&FWD (n=10)
0%
25%
50%
75%
100%
PSSM-FP TRD PME ME&HMD IEC MCRAH NMES CCSDP FP-FSD MIS
Achieved Partially Achieved Not Achieved Not Available

14. Summary of Progress of DLRs till June
2018
FY
# of DLRs Allocated
Total
Amount
Disbursed
Amount
To be
achieve
d
Fully
Achieved
Partially
Achieved
On Track DQA to be
completed
by IMED
More
information
required by
IMED
Yet to
report
to IMED
2016-17 14 7 1 1 4 1 - 88.35 54.50
2017-18 19 2 - - - - 17 65.10 8.00
Total 33 9 1 1 4 1 17 152.70 62.50
Out of the total RPA amount spent (US$ 227 million) in FY 2017-18, the amount sourced from 'RPA
Others' (i.e. JICA fund) was US$ 21 million. The rest US$ 206 million was sourced from 'RPA
through GOB' (i.e. through IPF-DLI mechanism). During this period, ONLY US$ 62.50 million could
be disbursed by the World Bank, which is 30% of the RPA fund utilized from the 'RPA through GOB'
source.

15. Physical Progress
July 2017– June 2018

16. • 1,14,322 normal deliveries took place in the public facilities
of Sylhet and Chittagong divisions under DGFP (n=47,417)
and DGHS (n=66,905).
• Completed special service delivery programme for Forcibly
Displaced Myanmar Nationals (FDMN) in Teknaf and Ukhia
upazila in Cox’s Bazar district and Naikhangchari upazila in
Bandarban district.
• The public facilities under DGFP provided at least 4 ANC to
4,10,626 pregnant mothers and ensured 6,34,373 deliveries
by skilled birth attendants (SBAs).
• DGHS finalized the operational guidelines for Multipurpose
Health Volunteers (MHV) and developed the referral
strategy from CC to USC/UzHC.
Major Progress in Strengthening
Institutions and Services (I)

17. • Developed National Child Health Strategy Bangladesh, 2017-
2022 and sent to Ministry for endorsement.
• Finalized the National Strategy of Maternal Health and
Maternal Health Standard Operating Procedures (Vol: 1&2).
• Developed institutional antimicrobial guideline (for
different medical colleges/ national institutes), monitoring
& evaluation for ensuring adherence to antimicrobial
guideline
• DGHS successfully tested an electronic platform for tracking
license and renewal process of private clinics and diagnostic
centre.
• During the reporting period, 1500 CCs reported gender
segregated data in DHIS2
Major Progress in Strengthening
Institutions and Services (II)

18. Major Progress in Strengthening
Institutions and Services (III)
• MOHFW prepared and disseminated the Program
Implementation Report (PIR)-January-June 2017, Six-monthly
Progress Report (SmPR)-July-December 2017 and HPNSDP
endline evaluation report.
• eMIS scaled up in 586 new UHFWCs.
• Completed Bangladesh Health Facility Survey (BHFS)-2017 and
Bangladesh Demographic and Health Survey (BDHS)-2017.
• Completed the preparatory activities of Adolescent Health and
Well-being Survey.
• Produced 2,925 registered midwives.
• Completed roll-out of the Asset Management System in the 250-
bed hospitals of Manikganj, Sirajganj and Jhenaidah districts.
Prepared the preliminary draft for “condemnation of assets:
guidelines and SOPs” and submitted for review.

19. Training Progress
July 2017– June 2018

20. Training Expenditure
94%
22%
66%
12%
6%
Workshop
Local Training
Foreign Training
Total expenditure = training cost (6%) +
other program cost (94%)
Distribution of training cost

21. Training Participants
N= 962,945 Participants
*In addition, 1,381 unclassified participants were trained by HEF and NEC OP.
10302
348865
942508420
168196
330433
MOHFW Central MOHFW Field Non-MOHFW participants
Local Training Foreign Training Workshop
1077 participants
attended foreign training

22. Gender distribution of training
participants
Male
56%
Female
44%

23. Implementation Challenges (I)
Areas of Key Challenges reported by LDs
18
15 15
5
4
3
Human
resources
Fund release Procurement Implementation Monitor. &
Supervison
Other

24. Implementation Challenges (II)
• 14 OPs from HSD and 7 OPs from ME&FWD mentioned
their challenges as summarized below:
– Issues with HR including shortage, frequent transfers
key positions and vacancy in sanctioned position etc.
– Insufficient skilled/technical manpower (Biomedical
Engineer, M&E, MIS/IT expert, Procurement specialist
etc.)
– Delayed fund release/disbursement
– Delayed and lengthy/time consuming procurement
process
– Issues with iBAS++ software implementation
– Enhancements of DHIS2/HMIS
• 8 OPs (HSD-5, ME&FWD-3) did not report having
faced challenge

25. key recommendations made by the LDs (I)
• Organize training programs for LDs, PMs, DPMs,
accountants on fund release procedures and
development of procurement plan
• Strengthen collaboration and co-ordination with
private sector and professional bodies for effective
implementation of urban TB program.
• Providing reward/incentives to CSBAs may
strengthen the referral mechanism to improve facility
delivery
• Initiatives may be taken for in-county production of
TB drugs with WHO prequalification.
• Organize refresher training for the relevant
personnel on iBAS++.

26. key recommendations made by the LDs
(II)
• Improve utilization of DHIS2 data to enhance program
performance and ensure accountability.
• Review and revise the OP level indicators.
• Ensure the quality of monitoring workshops held at field
level and improve the quality of workshop report
• Create permanent positions (TB & Lab Experts, MT Lab,
Microbiologist) at all levels using revenue budget and it’s
to be taken to the highest level of policy attention to ensure
a sustainable TB program run by GoB.
• Consult with relevant LD could be made before
transferring trained technical staff under his supervision
• Organize training for newly recruited manpower especially
the CHCPs (basic training and other programmatic
training).

27. Progress updates
Progress updates
• Implementation progress of the health-related
SDGs
• DLI-based funding modality: a preliminary
assessment of its functioning

28. Issues of Importance:
• Augmenting resources and reducing financial gaps
• Urban primary health care service
• Prevention and control of NCDs – a priority of the
4th HPNSP
• Quality Improvement Initiatives
Special notes on
Emergency health response to the Rohingya influx
Issues of Importance and special notes

29. Thank You