The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Sint Maarten Hospital Resiliency & Preparedness Project (P167532) LATIN AMERICA AND CARIBBEAN | St Maarten | Health, Nutrition & Population Global Practice | Recipient Executed Activities | Investment Project Financing | FY 2019 | Seq No: 11 | ARCHIVED on 21-Feb-2024 | ISR59553 | Implementing Agencies: Sint Maarten Medical Center (SMMC), Sint Maarten Medical Center (SMMC) Key Dates Key Project Dates Bank Approval Date: 16-Aug-2018 Effectiveness Date: 06-Sep-2018 Planned Mid Term Review Date: 31-Aug-2021 Actual Mid-Term Review Date: 19-Aug-2021 Original Closing Date: 31-May-2025 Revised Closing Date: 31-May-2025 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) Improve the preparedness and capacity of hospital services in Sint Maarten Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Building and launching of the new hospital:(Cost $24000000.00 M) Transition and Contingency Plan for Sint Maarten Medical Center:(Cost $11085000.00 M) Project Management:(Cost $525000.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Low Low Implementation Status and Key Decisions Following approval in August 2018, the Sint Maarten Hospital Resiliency and Preparedness Project was formally launched in October 2018, with the objective of the capacity and preparedness of hospital services in Sint Maarten. This project is not only supporting financing towards a new hospital building resilient to Category 5 storms, but also improvements to the expansion and quality of hospital services for the population of Sint Maarten. In August 2023, a second additional grant in the amount of US$7 million was approved to help cover a cost overrun resulting from an increase in the cost of construction. The project was restructured in August 2023 to adjust funds across expenditure categories, modify the results framework, and extend the original grant’s closing date by 10 months to May 31, 2025. Project implementation progress remains satisfactory. Significant progress on the new hospital construction continues with fast track activities (such as the water tanks, installation of base isolators and waste water treatment plant) well underway and all seven concrete pours for the main building foundation completed. Additionally, recent progress has been made on strengthening hospital service delivery preparedness: the SMMC Facilities Department held its first fire drill following the COVID-19 pandemic on April 5, 2023 and SMMC participated in an island-wide HUREX drill, which included hurricane preparedness, on May 1-9, 2023. Annual fire drills are expected to resume in 2024. The essential upgrades to the existing facility (all completed) have made an important contribution to improving the 2/21/2024 Page 1 of 7 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) capacity of hospital services as well as SMMC’s progress towards transitioning to the new building. As a result, the scope of current hospital services has been expanded and overseas referrals have been reduced over the past five years. Activities supported by the project have contributed to repairing structural damages caused by Hurricane Irma; increasing safety, preparedness and overall resilience of the current hospital; expanding the capacity of select services (e.g., dialysis, chemotherapy, and operating rooms) and providing new services (e.g., ophthalmology, neurology, urology, etc.), among others. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Moderate Moderate Macroeconomic Substantial Moderate Moderate Sector Strategies and Policies Moderate Low Low Technical Design of Project or Program Moderate Low Low Institutional Capacity for Implementation and Substantial Low Low Sustainability Fiduciary Substantial Moderate Moderate Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Low Low Results PDO Indicators by Objectives / Outcomes Improve capacity of hospital services IN01389439 ►Overseas medical referrals reduced (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 91.00 91.00 45.00 Date 31-May-2018 07-Mar-2023 07-Mar-2023 31-Jul-2024 This indicator measures the percent decrease in the number of overseas medical referrals. A referral is defined based on the date SMMC determines they cannot provide treatment at SMMC. Comments: 2/21/2024 Page 2 of 7 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Improve preparedness of hospital services IN01389440 ►Emergency Disaster Preparedness Plan and Evacuation Plan implemented according to procedures (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 90.00 91.80 90.00 Date 31-May-2018 31-Aug-2023 05-Dec-2023 30-May-2025 The first fire drill following the COVID-19 pandemic was held by the Facilities Department on April 5, 2023, and the Maintenance, Facilities Department and Patient Care participated in the island wide HUREX drill, which covered hurricane preparedness, from May 1-9, 2023. Annual fire drills are expected to resume in 2024. Following these recent trainings, the scorecard for the EDP and Evacuation Plan at SMMC are currently rated at 9.18 out of 10 or 91.8 percent, surpassing the Project’s end-target of 90 percent. This score is broken down into 8.8 for the Emergency and Evacuation Plan and 9.6 for Hurricane Comments: Preparedness. To improve the scoring, updating the hospital floor plans (delayed due to the ongoing expansion and upgrades to the facility) and conducting refresher courses on the fire alarm systems and extinguishers are needed. Due to the hospital's solid concrete walls, two scorecard indicators are marked as "Partially Met" and will not be achievable until the hospital relocates to a new building. IN01389441 ►Technical audits to evaluate quality and preparedness of service delivery rated satisfactory (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 40.00 40.00 90.00 Date 31-May-2018 07-Sep-2023 07-Sep-2023 30-May-2025 Internal technical audits will determine whether clinical guidelines and quality control mechanisms have been implem and the percentage of these cases that are rated Satisfactory. A draft audit tool for technical audits has been prepare Comments: for updating clinical practice guidelines continues. As of Jan 2024, an audit has been conducted of 5 of the 10 targete been considered satisfactory. Intermediate Results Indicators by Components Building and launching of the new hospital IN01389442 ►Progress in construction of new hospital as per category 5 plus specifications (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 25.00 26.00 45.00 Date 31-May-2018 07-Sep-2023 29-Dec-2023 30-May-2025 This indicator measures the percentage progress in construction of the new hospital as per Category 5 plus specifications. The end-target was revised downward to 45% as part of the July 2023 restructuring to appropriately reflect that construction was not projected to be completed during the lifetime of the project. Comments: The 45% end-target is derived from the construction timetable. The design phase is also included in the calculation as part of the overall progress in construction. 2/21/2024 Page 3 of 7 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) IN01389444 ►Emergency Disaster Preparedness Plan and Evacuation Plan updated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Jun-2018 15-Apr-2022 29-Dec-2023 31-Jul-2024 The end-target for this indicator will not be extended to reflect the Project's new closing date as it has already been a Comments: IN01389446 ►Health personnel trained (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 287.00 301.00 300.00 Date 01-Jun-2018 20-Sep-2023 05-Dec-2023 30-May-2025 As of December 2023, the training programs supported by this Project have benefitted 301 participants, Comments: reflecting an increase of 177 participants since 2022. IN01389448 ►Storage capacity to improve preparedness (Square Meter(m2), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 82.00 400.00 400.00 208.00 Date 01-Jun-2018 07-Mar-2023 07-Mar-2023 31-Jul-2024 Greater storage capacity is needed to ensure the provision of services even when extreme weather does not allow for the delivery of supplies. For now, storage capacity has increased by renting additional Comments: storage space off premises. SMMC is planning a permanent structure near the hospital that will increase storage for both sterile and non-sterile items beyond the target. IN01389451 ►Impact of extreme weather conditions on hospital services (admissions, referrals, surgeries) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 60.00 60.00 20.00 Date 31-May-2018 15-Apr-2022 29-Dec-2023 31-Jul-2024 **No category 2 events have occurred during the reporting period to allow for reporting on this indicator.** This indicator measures the percent change of services provided 60 days before and 60 days after an extreme weather event to gauge the impact of the event on the hospital's capacity to remain operational. The specific services tracked will include the number of admissions, surgeries and referrals. "Extreme Comments: weather conditions" include Category 2 hurricanes and higher. In the possible case of multiple, back to back extreme weather events, the indicator would measure 60 days before the first event and 60 days after the last event. Transition and Contingency Plan for Sint Maarten Medical Center IN01389443 2/21/2024 Page 4 of 7 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) ►Progress in essential upgrades to the existing hospital (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 01-Jun-2018 30-Jun-2023 29-Dec-2023 31-Jul-2024 This indicator measures the percent progress of essential upgrades completed to the existing facility. All essential upgrades were completed as of end-June 2023. The end-target for this indicator will not be Comments: extended to reflect the Project's new closing date as it has already been achieved. IN01389445 ►Contingency Plan in place for continuous services during works and reallocation of services (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Jun-2018 07-Mar-2023 29-Dec-2023 31-Jul-2024 An updated contingency plan (fall back scenario in case of disasters) remains in place for continuous Comments: services during works and reallocation of services. IN01389447 ►Increased patient satisfaction (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 73.00 81.40 85.00 Date 01-Jun-2018 07-Sep-2023 29-Dec-2023 30-May-2025 SMMC patient satisfaction surveys – already existing mechanism that has been enhanced, including disaggregation of results by gender. Since April 2021, SMMC has been piloting a new approach to the patient satisfaction surveys in order to reach more patients. Quick response (QR) code cards are being Comments: implemented in the Outpatient Department. To date, this new virtual mode of collecting data has increased responses since the onset of the pandemic. IN01389449 Increased patient satisfaction - females (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 80.20 81.40 85.00 Date 02-Jul-2018 20-Sep-2023 29-Dec-2023 30-May-2025 IN01389450 ►Updated clinical guidelines for prevalent health problems implemented and evaluated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.00 5.00 10.00 Date 01-Jun-2018 07-Sep-2023 29-Dec-2023 30-May-2025 Comments: This indicator is measured as part of the technical audit and the end-target was revised downward (from 20) as part of the July 2023 project restructuring. The five clinical guidelines conducted to date are for Status Epilepticus (CG1SE), Cholelithiasis (CG2CH), Hemorrhagic Stroke (CG3HS), Polycystic Ovary 2/21/2024 Page 5 of 7 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Syndrome (CG4PCOS) and Nonsteroidal anti-inflammatory drugs (CG5NSAID). An additional seven clinical guidelines are expected to be evaluated in May 2024. IN01389452 ►Hospital implemented a triage and treatment system including split services between COVID-19 and non-COVID-19 patients (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 16-Mar-2020 15-Apr-2022 29-Dec-2023 31-Jul-2024 IN01389453 ►Number of additional hospital beds to manage and treat COVID-19 suspected and confirmed patients. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 16.00 16.00 16.00 Date 16-Mar-2020 07-Mar-2023 29-Dec-2023 31-Jul-2024 The Auxiliary Care Facility has a total of sixteen beds, of which six are intensive care beds and 10 are Comments: medium care beds to manage and treat COVID-19 suspected and confirmed cases. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P167532 TF-A8176 Effective USD 25.00 25.00 0.00 22.67 2.33 91% P167532 TF-B3788 Effective USD 3.61 3.61 0.00 3.61 0.00 100% P167532 TF-C2387 Effective USD 7.00 7.00 0.00 0.00 7.00 0%% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P167532 TF-A8176 Effective 10-Aug-2018 22-Aug-2018 06-Sep-2018 31-Jul-2023 31-May-2025 P167532 TF-B3788 Effective 26-Aug-2020 03-Sep-2020 30-Oct-2020 31-Jul-2024 31-Jul-2024 P167532 TF-C2387 Effective 22-Aug-2023 05-Dec-2023 21-Dec-2023 31-May-2025 31-May-2025 Cumulative Disbursements 2/21/2024 Page 6 of 7 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Restructuring History Level 2 Approved on 31-Jul-2023 Related Project(s) P174023-Additional Financing for the Sint Maarten Hospital Resiliency & Preparedness Project ,P180854-Second Additional Financing for the Sint Maarten Hospital Resiliency and Preparedness Project 2/21/2024 Page 7 of 7