The World Bank Implementation Status & Results Report Health System Strengthening Project (P175170) Health System Strengthening Project (P175170) EAST ASIA AND PACIFIC | Tuvalu | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2022 | Seq No: 1 | ARCHIVED on 19-Oct-2022 | ISR53288 | Implementing Agencies: Ministry of Health, Social Welfare and Gender Affairs, Tuvalu Key Dates Key Project Dates Bank Approval Date: 29-Jun-2022 Effectiveness Date: 03-Aug-2022 Planned Mid Term Review Date: 03-Aug-2025 Actual Mid-Term Review Date: Original Closing Date: 30-Jun-2028 Revised Closing Date: 30-Jun-2028 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objectives (PDOs) are to improve delivery of select health services, strengthen health management systems, and in case of an Eligible Crisis or Emergency, respond promptly and effectively to it. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Improve the Availability of Essential Public Health and Health Care Services Provided at Princess Margaret Hospital:(Cost $9.91 M) Strengthen the Delivery of Primary Health Care and Primary Prevention, with a Focus on Non-Communicable Diseases:(Cost $3.02 M) Support the Development of Management Systems:(Cost $2.07 M) Contingent Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO -- Satisfactory Overall Implementation Progress (IP) -- Satisfactory Overall Risk Rating -- Substantial Implementation Status and Key Decisions This is the initial ISR for the Tuvalu Health System Strengthening Project. The project was approved on July 19, 2022, and became effective on August 3, 2022. The Bank is providing Hands-on Expanded Implementation Support for an initial period of 18-months to support the Central Project Management Office to select and recruit key Project Management Unit staff. 10/19/2022 Page 1 of 9 The World Bank Implementation Status & Results Report Health System Strengthening Project (P175170) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate -- Moderate Macroeconomic Moderate -- Moderate Sector Strategies and Policies Moderate -- Moderate Technical Design of Project or Program Moderate -- Moderate Institutional Capacity for Implementation and Substantial -- Substantial Sustainability Fiduciary Substantial -- Substantial Environment and Social Moderate -- Moderate Stakeholders Low -- Low Other Moderate -- Moderate Overall Substantial -- Substantial Results PDO Indicators by Objectives / Outcomes Improve Delivery of Select Health Services IN01197821 ►Increase in the availability of essential hospital services at Princess Magraret Hospital (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Availability of services No service increased at PMH in at Value No service improvement -- improvement least four service areas Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 A service delivery assessment would be conducted in Year 1 and from that assessment agreement would be reached on a specific enhanced service delivery capacity at PMH. It is expected that tracer services would be agreed in four categories: (i) diagnostic, including radiological and public health; (ii) general Comments: surgery; (iii) mental health; and (iii) integrated approach to NCD management. The PDO indictor will measure the process of developing the PMH and ultimately the final target would be that the defined tracer services are in place and functional. IN01197823 Increase in the Diagnostic (radiological and laboratory) Capacity (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Availability of Tracer Value No increase in capacity -- No increase in capacity Services Defined as 10/19/2022 Page 2 of 9 The World Bank Implementation Status & Results Report Health System Strengthening Project (P175170) part of agreed Service Plan Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 IN01197824 Increase in the General Surgery Capacity (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Availability of Tracer Services Defined as Value No increase in capacity -- No increase in capacity part of agreed Service Plan Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 IN01197825 Increase in the mental health and counseling capacity (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Availability of Tracer Services Defined as Value No increase in capacity -- No increase in capacity part of agreed Service Plan Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 IN01197826 Increase in the Integrated NCD Management Capacity (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Availability of Tracer Services Defined as Value No increase in capacity -- No increase in capacity part of agreed Service Plan Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 IN01197827 ►Increase in the percentage of screened adults with a 10-year cardiovascular disease (CVD) risk ≥30% or with existing hypertension or diabetes that are being managed for their condition (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 Numerator: NCD Patients who have had a follow-up visit in the last six months Denominator: Total Comments: Number of Screened adults with a 10-year CVD risk ≥30% or with existing CVD IN01197828 Percentage of Managed NCD Patients - Female (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 IN01197829 Percentage of Managed NCD Patients - Male (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 10/19/2022 Page 3 of 9 The World Bank Implementation Status & Results Report Health System Strengthening Project (P175170) Value 0.00 -- 0.00 50.00 Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 Strengthen Health Management Systems IN01197822 ►Public feedback mechanism operational, feedback analyzed and published in Ministry of Health, Social Welfare and Gender Affairs’ Annual Report (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target No established system No established system for receiving or for receiving or Analysis from Public responding to public or responding to public or Feedback System Value -- patient feedback patient feedback included in Annual (complaints, feedback, (complaints, feedback, Health Report suggestions, suggestions, comments) comments) Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 The definition of the operational public (patient) feedback system indicates that the system would have at least following four elements: (i) highly accessible to the population; (ii) would be receiving feedback Comments: (complaints, comments, suggestions); (iii) would respond to most of the feedback providers, i.e. more than 80%, through a process defined by standard operating procedures; and (iv) would analyze the feedback provided for informing the health sector performance. Intermediate Results Indicators by Components Improve the Availability of Essential Public Health and Health Care Services Provided at PMH IN01197830 ►PMH Physical Capacity Increased (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target New PMH Wing Value No extension of PMH -- No extension of PMH Constructed, Equipped and Put into Operation Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 Comments: Indicator measures intermediate steps towards the design and construction of the PMH Wing/Building IN01197833 ►PMH Human Resource Capacity Increased (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target HR Development Plan Implemented including (i) contractual human resources through Value No Plan -- No Plan teleconsultation or in- country assignments; (ii) short-term training of PMH health professionals; (iii) 10/19/2022 Page 4 of 9 The World Bank Implementation Status & Results Report Health System Strengthening Project (P175170) short-term stays of visiting medical teams Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 The Human Resource Development plan will include plans and support for: (i) contractual human Comments: resources through teleconsultation or in-country assignments; (ii) short-term training of PMH health professionals; (iii) short-term stays of visiting medical teams. Strengthen the Delivery of Primary Health Care and Primary Prevention, with a Focus on NCDs IN01197832 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 239,631.00 Date 30-Jun-2022 -- 04-Oct-2022 31-Dec-2027 IN01197835 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 121,014.00 IN01197837 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 1,500.00 Date 31-Dec-2021 -- 04-Oct-2022 31-Dec-2027 IN01197838 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 0.00 Date 30-Jun-2022 -- 04-Oct-2022 31-Dec-2027 IN01197839 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 1,500.00 Date 30-Jun-2022 -- 04-Oct-2022 31-Dec-2027 IN01197840 ►Adult Population Screened for Non-Communicable Disease (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 10/19/2022 Page 5 of 9 The World Bank Implementation Status & Results Report Health System Strengthening Project (P175170) Value 0.00 -- 0.00 40.00 Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 Numerator: Defined as adult population (age over 30), disaggregated by male and female, screened for Comments: having or the risk of developing hypertension and/or diabetes mellitus; Denominator: Estimate of Adult Population over the age of 30 IN01197841 Percentage of Adult Population Screened that are Female (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 IN01197842 Percentage of Adult Population Screened that are Male (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 IN01197843 ►Number of health facilities maintaining service readiness according to guidelines (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 11.00 Date 30-Jun-2022 -- 04-Oct-2022 30-Jun-2028 A routine system for measuring and monitor the service readiness of health clinics will be established and Comments: routinely measured IN01197844 ►Progress Against MANA Framework for NCD Primary Prevention (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 42.00 -- 42.00 50.00 Date 31-Dec-2020 -- 04-Oct-2022 31-Dec-2027 The MANA Framework refers to the Dashboard for Noncommunicable Disease (NCD) Action, developed Comments: by the Pacific Monitoring Alliance for NCD Action (MANA). An area in green means that it is in progress. The number of stars assess the degree of implementation. 105 stars total possible across 8 domains. IN01197845 ►Percent of identified First Responders with knowledge to provide appropriate GBV services (detection, response and referral) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 70.00 Date 30-Jun-2022 -- 04-Oct-2022 31-Dec-2027 10/19/2022 Page 6 of 9 The World Bank Implementation Status & Results Report Health System Strengthening Project (P175170) First responders would include counselors, police cadre and specified health workforce. Numerator = Comments: those who have been trained according to the guidelines and who demonstrate increased knowledge (i.e. through pre-test and post-test analysis). Denominator will be defined as part of the program development. IN01197846 ►System established for collecting sex-disaggregated data on screening and management of NCD patients (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No -- No Yes Date 30-Jun-2022 -- 04-Oct-2022 31-Dec-2027 This will measure the availability of a digital tool to track individuals who have been (i) screened; (ii) risk Comments: ratings identified; and (iii) are being managed for hypertension or diabetes or at high risk of developing the diseases. The system would be able to disaggregate the data by sex. Supporting the Development of Management Systems IN01197831 ►Asset Management System Established and Maintained (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Asset Management System with an inventory of all major No Asset Management No Asset Management Value -- medical equipment System exists System exists and physical building assets established and maintained Date 30-Jun-2022 -- 04-Oct-2022 31-Dec-2027 The Asset Management System is system with an inventory of all significant assets (medical equipment, Comments: information systems, information communication technologies, physical buildings) that would improve the life-cycle approach to managing those assets. IN01197834 ►Strategy determined for having functional and fit for purpose Hospital Management Information System (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Current Hospital Current Hospital Management Management Information Information does not does not fully work A strategy would be fully work across across hospital agreed for adapting or hospital departments, Value departments, is designed -- replacing HMIS with a is designed for a large for a large tertiary facility, costed and specific tertiary facility, includes text in foreign action plan includes text in foreign characters, and is not characters, and is not sufficiently maintained. sufficiently maintained. Date 30-Jun-2022 -- 04-Oct-2022 31-Dec-2027 The strategy will include an assessment of the existing system and the health information echo-system; definition of the functionality (clinical, administrative, technical) required; definition of the context in terms Comments: of human resources, technical capabilities, etc.; analysis of options to replace or update of the HMIS based on cost and feasibility; and detailed plan based on the preferred option. IN01197836 ►Public Feedback System Designed and Established for the Health System (Text, Custom) 10/19/2022 Page 7 of 9 The World Bank Implementation Status & Results Report Health System Strengthening Project (P175170) Baseline Actual (Previous) Actual (Current) End Target A public feedback Value No System in Place -- No System in Place system is operational Date 30-Jun-2022 -- 04-Oct-2022 31-Dec-2027 A public feedback will be designed and put into operation that will include: (i) highly accessible to the Comments: public; (ii) receives feedback on a regular basis; (iii) response is provided to the feedback provider (i.e. at least 80%), according to standard operating procedures; and (iv) informs health sector performance. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P175170 IDA-E0860 Effective USD 15.00 15.00 0.00 0.00 14.81 0% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P175170 IDA-E0860 Effective 29-Jun-2022 19-Jul-2022 03-Aug-2022 30-Jun-2028 30-Jun-2028 Cumulative Disbursements 10/19/2022 Page 8 of 9 The World Bank Implementation Status & Results Report Health System Strengthening Project (P175170) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 10/19/2022 Page 9 of 9