The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Tamil Nadu Health System Reform Program (P166373) SOUTH ASIA | India | Health, Nutrition & Population Global Practice | Requesting Unit: SACIN | Responsible Unit: HSAHN IBRD/IDA | Program-for-Results Financing | FY 2019 | Team Leader(s): Dinesh M. Nair, Aarushi Bhatnagar, Rahul Pandey Seq No: 11 | ARCHIVED on 23-May-2024 | ISR60638 | Created by: Dinesh M. Nair on 06-May-2024 | Modified by: Dinesh M. Nair on 17-May-2024 Program Development Objectives PDO Table Program Development Objective (from Program Appraisal Document) The Program Development Objective (PDO) is to improve quality of care, strengthen management of non-communicable diseases and injuries, and reduce inequities in reproductive and child health services in Tamil Nadu. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Implementation Status and Key Decisions TNHSRP ends on a high note with all six results PDO and eleven Intermediate Results expected to be fully achieved, and the State geared to mainstream and sustain the gains achieved over the Program’s period. While the Program is closing end of May 2024, a few pending results are in the process of completion and/or verification process. The Program is expected to fully disburse. The TNHSRP has been crucial to the implementation of several large programmatic interventions and innovations and the Program has had several landmark achievements which herald their way to a stronger and adaptive health system. Some of the key initiatives enabling these achievements include transforming people-centered quality of care through district and state health assemblies to complement various supply-side interventions, fostering a multi-faceted and multi-sectoral approach to addressing non-communicable diseases and trauma care, and innovating and implementing using relevant and timely findings from the operational research program. Considering the Program supported the effective implementation of State and National programs, the likelihood of continuity of TNHSRP interventions and sustaining of gains are high. A process is ongoing to document and share the lessons from Tamil Nadu to other Indian States and neighboring countries which are faced with similar challenges. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P166373 IBRD-89340 Effective USD 287.00 287.00 0.00 209.99 77.01 73% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P166373 IBRD-89340 Effective 19-Mar-2019 04-Jun-2019 29-Jul-2019 31-May-2024 31-May-2024 5/23/2024 Page 1 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) DLI Disbursement Achievement Disbursed amount in Disbursement % for DLI ID DLI Type Description Coc DLI Amount Status Coc DLI Loan: IBRD89340-001 DLI1 Impl of imr in Pri Sec Partially 1 Regular USD 49,497,000.00 36,990,200.00 75 % Tert fac Achieved DLI2 Inc no of Pub Fac Partially 2 Regular USD 35,650,000.00 34,800,000.00 98 % with Certifi Achieved DLI3 Inc Shr of adult Hyp Partially 3 Regular USD 57,885,500.00 14,985,500.00 26 % Diab under Cnt Achieved DLI4 Impr Prov of Trauma 4 Regular USD 16,250,000.00 Fully Achieved 16,250,000.00 100 % Care Serv DLI5 Inc Util Reprod Child 5 Regular USD 56,500,000.00 Fully Achieved 56,500,000.00 100 % Serv Prio Dis DLI6 Strgn Cont, Qual, Partially 6 Regular USD 21,000,000.00 6,000,000.00 29 % Access Dec Mak Achieved DLI7 Strgn Coord, Integ, Partially 7 Regular USD 35,750,000.00 33,250,000.00 93 % Perf bas Mgt Le Achieved DLI8 Inc transp, account, Partially 8 Regular USD 13,750,000.00 10,500,000.00 76 % Citi Eng Achieved Program Action Plan Increase bidder participation: (i) establish procurement complaint redressal system; and (ii) organize annual supplier Action Description forum/conferences Source DLI# Responsibility Timing Timing Value Status TNMSC, ELCOT, Fiduciary Systems Recurrent Continuous Completed PWD Completion Measurement (i) procurement complaint redressal system established; (ii) annual supplier forum/conferences organized Comments Strengthen FM capacity in NHM: (i) assessment to identify gaps in staffing and policies; (ii) training programs for Action Description accounting staff; (iii) greater use of expenditure module of PFMS; (iv) strengthen concurrent audit system. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NHM Society Recurrent Continuous Completed Completion Measurement (i) gap assessment report; (ii) training programs organized; (iii) PFMS usage report; and (iv) concurrent audit report Comments 5/23/2024 Page 2 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Enhance transparency: (i) publicly disclose contract awards of value greater than INR 20 Million (approx. US$ Action Description 285,720); and (ii) collate information on fraud and corruption-related complaints and provide information to WB on a quarterly basis Source DLI# Responsibility Timing Timing Value Status TNMSC, ELCOT, Fiduciary Systems PWD; Secretariat, Recurrent Continuous Completed DOHFW (i) report on disclosure by the procurement agencies; and (ii) quarterly report on fraud and corruption-related Completion Measurement complaints Comments Action Description BMWM: performance audits for the CTFs have to be undertaken Source DLI# Responsibility Timing Timing Value Status Environmental and Social TNHSRP PMU Recurrent Yearly Completed Systems Completion Measurement Annual performance audit conducted and reports publicly disclosed by the competent authority Comments Being done regularily Action Description Introduce continuous refresher trainings on biomedical and other waste management Source DLI# Responsibility Timing Timing Value Status Environmental and Social TNSHRP PMU and Recurrent Continuous Completed Systems DME Completion Measurement New refresher training course rolled out for healthcare staff across all healthcare facilities Comments Being done regularily Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Moderate Moderate Macroeconomic Low Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Low Moderate Moderate Sustainability 5/23/2024 Page 3 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Fiduciary Moderate Moderate Moderate Environment and Social Moderate Moderate Moderate Stakeholders Low Low Low Other Low -- Low Overall Moderate Moderate Moderate Results PDO Indicators by Objectives / Outcomes Improved Quality of Care and Reduced Equity Gaps in Reproductive and Child Health IN01425297 ►Increased number of public facilities with quality certification (primary, secondary, and tertiary) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target i) Tertiary i) Tertiary (i) Tertiary facilities facilities with entry level facilities with entry level with entry level NABH NABH accreditation: 3 NABH accreditation: 3 (i) Tertiary facilities certification: 4 (ii) Secondary (ii) Secondary with entry level NABH (ii) Secondary facilities facilities with NQAS facilities with NQAS accreditation: 0 with NQAS certification: 65 out of certification: 75 of which (ii) Secondary certification: 75 of which 13 are in priority 15 are in priority Value facilities with NQAS which 15 are in the districts districts certification: 3 priority districts (iii) Primary (iii) Primary (iii) Primary facilities (iii) Primary facilities facilities with NQAS facilities with NQAS with NQAS certification: 4 with NQAS certification: 300 out of certification: 300 of certification: 300 of which 60 are in priority which 60 are in priority which 60 are in the districts districts priority districts Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Comments IN01425312 Tertiary facilities with entry level NABH certification (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3.00 3.00 4.00 Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 IN01425316 Secondary facilities with NQAS certification (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 65 out of which 13 is in 75 out of which 15 are in 70 of which 14 are in Value 3.00 priority districts the priority districts the priority districts Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 IN01425321 Primary facilities with NQAS certification (Text, Custom Breakdown) 5/23/2024 Page 4 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Baseline Actual (Previous) Actual (Current) End Target 300 out of which 60 are 300 out of which 60 are 300 of which 60 are in Value 4.00 in priority districts in priority districts the priority districts Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Improved Quality of Care IN01425298 ►Improved scores in quality score card for primary, secondary, and tertiary level facilities (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target NA – to be measured after Value quality dashboard is 65.00 65.00 65.00 established Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Final analysis is in progress and value may change Comments Strengthened Management of Non-Communicable Diseases and Injuries IN01425311 ►Increased screening in public sector facilities for cervical and breast cancers (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Cervical cancer: 16% Cervical cancer: 17% Cervical cancer: 15.8% Breast cancer: 19% Breast cancer: 23% Cervical cancer: 16% Value Breast cancer: 19.5% Breast cancer: 19% Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Comments IN01425315 Cervical cancer (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 15.80 16.00 17.00 16.00 Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 IN01425319 Breast cancer (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 19.50 19.00 23.00 19.00 Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Improved Quality of Care and Strengthened Management of Non-Communicable Diseases and Injuries IN01425299 ►Increased share of adults with hypertension or diabetes whose blood pressure or blood sugar are under control (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 5/23/2024 Page 5 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Hypertension under control: 3 percentage Hypertension under point increase from control:7.3% Steps Survey - Round II Hypertension under baseline Value Diabetes under control: to be conducted in control:17% Diabetes under 10.8% October 2023 Diabetes under control: control: 6 percentage 16.7% point increase from baseline Date 30-Apr-2021 30-Oct-2023 10-May-2024 01-Jul-2024 Comments IN01425313 Hypertension under control (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Steps Survey - Round II 3 percentage point Value 7.3% to be conducted in 17% increase from baseline October 2023 - 10.3% Date 30-Apr-2021 30-Oct-2023 10-May-2024 01-Jul-2024 IN01425317 Diabetes under control (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Steps Survey - Round II 6 percentage point Value 10.8% to be conducted in 16.7% increase from baseline October 2023 - 16.8% Date 30-Apr-2021 31-Mar-2023 10-May-2024 01-Jul-2024 IN01425320 ►Improved provision of quality trauma care services (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target i) # of trauma centers (i) # of trauma centers i) # of trauma centers using trauma registry: using trauma registry: 0 using trauma registry: 54 54 (ii) % of surgical ED (ii) % of surgical ED (ii) % of surgical ED admissions: 45.9% admissions: 55% admissions: 85% (iii) IFT protocols not (iii) Emergency (i) # of trauma centers (iii) Emergency available department established using trauma registry: department established Value (iv) Emergency in 25 MCH 54 in 25 MCH department not (iv) 13 Level-1 trauma (ii) % of surgical ED (iv) 13 Level-1 trauma established centres, 29 Level-2 admissions: 55% centres, 29 Level-2 (v) Level-1 and level-2 trauma centres trauma centres trauma care centers not established established available Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 No change in this indicator since the last mission, it was already achieved Comments IN01425323 # of trauma centers using trauma registry (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 54.00 54.00 54.00 5/23/2024 Page 6 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 IN01425324 % of surgical ED admissions (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 45.9% 55% 85% 55% Date 31-Mar-2021 30-Oct-2023 10-May-2024 01-Jul-2024 Reduced Equity Gaps in Reproductive and Child Health IN01425300 ►Increased utilization of reproductive and child health services in priority districts (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) Full ANC: 41.3% (i) Full ANC: 41.3% (ii) Fully immunized: (ii) Fully immunized: (i) Full ANC: 28.8% (i) Full ANC: 41.3% 70.4% 70.4% (ii) Fully immunized: (ii) Fully immunized: Value (iii) mCPR: 43.5% (iii) mCPR: 43.5% 57.9% 70.4% (iii) mCPR: 38.5% (iii) mCPR: 43.5% Cumulative target Cumulative target achieved achieved Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 No change in this indicator since the last mission, it was already achieved Comments IN01425314 Full ANC (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 28.80 41.30 41.30 41.30 Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 IN01425318 Fully immunized (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 57.90 70.40 70.40 70.40 Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 IN01425322 mCPR (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 38.50 43.50 43.50 43.50 Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Intermediate Results Indicators by Results Areas 5/23/2024 Page 7 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Result #1: Improved Quality of Care IN01425325 ►Implementation of quality improvement interventions in primary, secondary, and tertiary care facilities (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) Number of primary, (i) Number of primary, secondary, and tertiary secondary, and tertiary level facilities level facilities (i)Number of facilities implementing at least 1 implementing at least 1 implementing at least 1 (i) Number of primary, endorsed quality endorsed quality endorsed quality secondary, and tertiary improvement initiative improvement initiative improvement initiative level facilities from the list of evidence- from the list of from the list of implementing at least 1 based interventions evidence-based evidence-based endorsed quality specified in the QoC interventions specified interventions specified improvement initiative Strategy: 570 primary in the QoC Strategy: in the QoC Strategy: from the list of evidence- facilities and 248 570 primary facilities Primary: 570, based interventions Value secondary and tertiary and 248 secondary and Secondary: 248 and specified in the QoC facilities tertiary facilities tertiary:9 (ii) Strategy: 0 ………….. (ii) Number of Number of primary, (ii) Number of primary, (ii) Number of primary, facilities reporting on secondary, and tertiary secondary, and tertiary secondary, and tertiary quality scorecard facilities reporting on facilities reporting on facilities reporting on quarterly: Primary: 570 quality dashboard quality dashboard quality dashboard and Secondary: 248 quarterly: 0 quarterly: 570 primary quarterly: 570 primary and 248 secondary and and 248 secondary and tertiary facilities tertiary facilities Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 As per the update received from the PMU, this indicator has been achieved; however, verification and Comments disbursement against this DLR is pending and expected to be completed soon. IN01425328 ►Piloting of patient experience questionnaire for secondary & tertiary care facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 5.00 5.00 Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Comments Result #2: Strengthened Management of Non-Communicable Diseases and Injuries IN01425331 ►Increased share of primary & secondary facilities with at least one staff trained on mental health (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 31.00 41.05 40.00 Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Comments IN01425333 ►Establishment of suicide hotline (Yes/No, Custom) 5/23/2024 Page 8 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2021 Comments IN01425334 ►Better equipped ambulance system to improve pre-hospital care -number of ATLS ambulances providing Level 1 care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 64.00 205.00 205.00 164.00 Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Comments IN01425337 ►Improved capacity of trauma care providers - number of emergency department providers that received Level 3 (BTLS) and Level 4 training (ATLS) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Level 3: Nurses - Level 3: Nurses - 165; Level 3: Nurses - 6288; Level 3: Nurses - 6909; 6120; Doctors - 4313. Doctors - 100. Doctors - 3745. Doctors - 4537. Value Level 4: Nurses - 900; Level 4: Nurses - 0; Level 4: Nurses - 826; Level 4: Nurses - 951; Doctors - 600. Doctors - 0. Doctors - 600. Doctors - 624 Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Comments Result #3: Reduced Equity Gaps in Reproductive and Child Health IN01425327 ►Implementation of updated social and behavior change communication (SBCC) strategy (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes Date 01-Nov-2018 31-Mar-2023 10-May-2023 01-Jul-2024 Completed in FY 24. Comments IN01425330 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,082,246.00 4,082,246.00 3,600,000.00 Date 29-Mar-2019 30-Oct-2023 10-May-2024 01-Jul-2024 Comments IN01425335 Number of children immunized (Number, Corporate Breakdown) 5/23/2024 Page 9 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,082,246.00 4,082,246.00 3,600,000.00 Date 29-Mar-2019 30-Oct-2023 10-May-2024 01-Jul-2024 Cross-Cutting Results IN01425326 ►Strengthened content, quality, accessibility, and use of data for decision making (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Conceptual Model and Population health Operational Plan for a Population health Population health registry registry under roll out in strengthened and registry developed and Value under roll out in 1 district 1 district of the state. - integrated Health rolled out in 1 district of of the state completed; however, Management Information Tamil Nadu verification pending System (HMIS) : No Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Comments IN01425329 ►Strengthened coordination, integration, performance-based management, learning, and other cross-cutting functions for better results (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) Process for call for (i) Call for proposal for proposal and award for year 5, the broad themes year 5, has been are selected and completed. (ii) research questions under Deploying e- finalization. procurement system in (ii) Deploying e- TNMSC and 20% of procurement system in value of total contracts TNMSC and 20% of of TNMSC under the value of total contracts of Program done through TNMSC under the e-procurement: Program done through e- Completed (iii) (i) 1 annual call for procurement: Completed Development of the research proposals (iii) Development of the environmental strategy issued and selected environmental strategy of of the health sector has proposal awarded. the health sector has been completed. (iv) (ii) Program Steering Policies/Strategies: No been completed and Conducting and Committee meeting Value Institutional systems: No implementation of an reporting on monthly held during every operational plan is meeting of Program month of the year underway. Steering Committee (iii) implementation of (iv) Conducting and (PSC) of the TNHSRP: operational plan for reporting on monthly completed (v) environmental strategy meeting of Program Designating nodal Steering Committee officers in each (PSC) of the TNHSRP: In directorates and progress societies under the (v) Designating nodal PforR program officers in each boundary for TNHSRP directorates and societies with defined TOR and a under the PforR program coordination boundary for TNHSRP mechanism in place: with defined TOR and a Completed. (v) The coordination mechanism following under this in place: Completed. indicator were achieved 5/23/2024 Page 10 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) (v) The following under earlier: TN Health this indicator were Policy/Strategy, achieved earlier: TN operational research Health Policy/Strategy, program guidelines, operational research guidelines on program guidelines, professional guidelines on development program professional and environment development program strategy. (vi)(a) Energy and environment Efficiency Audit - strategy. Results discussed on (vi)(a) Energy Efficiency 9.10.23 (b) Liquid Audit - Results discussed Waste Management on 9.10.23 (b) Liquid Audit - Completed in 6 Waste Management Health Care Facilities Audit - Completed in 6 (c) BMWM - Initiated Health Care Facilities (c) BMWM - Initiated Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Comments IN01425332 ►Increased transparency and accountability through citizen engagement (voice, agency, and social accountability) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DHA for 79% districts Districts conducting Districts conducting Health and 1 SHA completed Health Assembly: DHA for 63% districts Value Assembly: 0%. Processes for 24 DHA 60%. and 1 SHA completed State Health Assembly: 0 and SHA in Fy 23-24 State Health underway Assembly: 1 Date 01-Nov-2018 30-Oct-2023 30-Oct-2023 01-Jul-2024 In the last ISR, reported progress was erroneously mentioned as 79%, while it is at 63% with 24 out of 38 Comments districts completing district health assembly IN01425336 Districts conducting Health Assembly (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0% 79% 63% ( 24 districts) 60% Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 IN01425338 State Health Assembly (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 1.00 Date 01-Nov-2018 30-Oct-2023 10-May-2024 01-Jul-2024 Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 Implementation of quality improvement interventions in primary, secondary, and tertiary care facilities (Output, 49,497,000.00, 0%) 5/23/2024 Page 11 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Baseline Actual (Previous) Actual (Current) Year 5 (i) At least 1 health facility implementing at least 1 endorsed (i) 427 primary- and 184 quality improvement secondary-level facilities initiative from the list have implemented facility of evidence-based quality committee interventions meetings (an endorsed specified in the QoC quality improvement Strategy: (i) 427 primary- and 184 initiative in the QoCS) for US$20,000 for each secondary-level facilities a minimum of 10 primary care facility have implemented facility months.The GoTN has up to 143 facilities, quality committee met year-5 target of 570 US$30,000 for each meetings (an endorsed primary and 248 secondary care quality improvement secondary facilities; facility up to 62 initiative in the QoCS) for however, verification is facilities and a minimum of 10 months. under progress. (ii) Health US$85,000 for each (ii) Health Facility Facility reporting on tertiary care facility reporting on quality quality scorecard during at up to 5 scorecard during at least Ad hoc implementation of least 3 quarters of the facilities...….(ii) At 3 quarters of the Value quality improvement reporting year: 166 least 1 health facility reporting year: 83 initiatives by hospitals secondary facility and 377 reporting on quality secondary facility and primary facilities. The score card during 193 primary facilities GoTN has met year-5 each quarter of the (iii) TANQuEST target of 570 primary and reporting year: implementation plan 248 secondary facilities; US$14,800 for each developed and adopted however, verification is additional primary by Tamil Nadu: Achieved under progress. (iii) care facility up to (iv) TANQuEST has been TANQuEST 190 facilities and piloted in at least one implementation plan US$22,000 for each medical college for a developed and adopted by additional secondary period of 6 months: In Tamil Nadu: Achieved (iv) care facility up to 82 progress TANQuEST has been facilities from the piloted in at least one previous medical college for a year………(iii) period of 6 months: In TANQuEST has progress – achieved and been piloted in at verification ongoing. least one Medical College for a period of 6 months: US$3,000,000 Date -- 31-Mar-2023 10-May-2023 -- Comments ►DLI 2 Increased number of public facilities with quality certification (primary, secondary and tertiary) (Outcome, 35,650,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Value (i) Tertiary: 0 (i) Tertiary: 0 (i) Tertiary: 3 (ii) (i) US$850,000 for (ii) Secondary: 3 (ii) Secondary: 63 Secondary: 75 every tertiary care (iii) Primary: 4 (out of which 10 in (out of which 15 in priority facility certified (up Tertiary = medical colleges priority districts) districts) (iii) to 2 such Secondary = district, taluk, (iii) Primary: 209 Primary: 300 facilities)…………...( and non-taluk hospitals (out of which 17 in (out of which 60 in priority ii) US$160,000 for Primary = PHCs and CHCs priority districts) districts) Tertiary = every additional Tertiary = medical medical colleges secondary care colleges Secondary = district, taluk, facility certified (up 5/23/2024 Page 12 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Secondary = district, and non-taluk hospitals to 21 facilities), with taluk, and non-taluk Primary = PHCs and an additional hospitals CHCs US$75,000 for each Primary = PHCs and of the first 2 that are CHCs in the priority districts...……...(iii) US$37,000 for every additional primary care facility certified (up to 79 facilities), with an additional US$15,000 for each of the first 10 that are in the priority districts Date -- 31-Mar-2023 10-May-2024 -- Comments ►DLI 3 Increased share of adults with hypertension or diabetes whose blood pressure or blood sugar are under control (Outcome, 57,885,500.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Value Baseline to be established (i) Baseline values (i) Baseline values (i) The percentage after STEPS is established on April 17, established on April 17, point increase in the implemented in 2019 2021 for (a) Percentage 2021 for (a) Percentage of share of of Hypertensives with BP Hypertensives with BP hypertensive adults under control - 7.3%; (b) under control - 7.3%; (b) whose blood Percentage of Diabetics Percentage of Diabetics pressure is under with Blood Sugar under with Blood Sugar under control over the control - 10.8%. The control - 10.8%. (ii) The previous survey second round of the percentage point increase (with statistical survey will be conducted in the share of diabetic significance) up to in Year 5. adults whose blood 3.0 percentage (ii) The percentage point glucose is under control points increase - increase in the share of over the previous survey: US$7.3 million for diabetic adults whose to be measured through every percentage blood glucose is under second round of STEPS point increase control over the previous survey, which has been ……………………… survey: to be measured conducted and DLR (ii) The percentage through second round of verification under point increase in the STEPS survey planned progress. (iii) The share of diabetic in Year 5 percentage point increase adults whose blood (iii) The percentage point in the share of glucose is under increase in the share of hypertensive adults whose control over the hypertensive adults blood pressure is under previous survey whose blood pressure is control over the previous (with statistical under control over the survey: to be measured significance) up to previous survey: to be through second round of 6.0 percentage measured through STEPS survey, which has points increase - second round of STEPS been conducted and DLR US$3 million for survey planned in Year 5 verification under progress every percentage (iv) A process evaluation (iv) A process evaluation point of the Makkalai Thedi of the Makkalai Thedi increase………(iii) Maruthuvam Scheme is Maruthuvam Scheme is At least 1 endorsed conducted: Achieved conducted: Achieved (v) initiative from the list (v) At least 1 endorsed At least 1 endorsed of evidence-based initiative from the list of initiative from the list of interventions evidence-based evidence-based specified in the NCD interventions specified in interventions specified in Strategy has been the NCD Strategy has the NCD Strategy has 5/23/2024 Page 13 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) been implemented by the been implemented by the implemented by the state in year 4 and 5 - state in year 4 and 5 - state: US$3,000,000 Achieved for Year 4; In Achieved for Year 4 and 5; progress for Year 5 however, verification for Year 5 ongoing. Date -- 31-Mar-2023 10-May-2024 -- Comments ►DLI 4 Improved provision of quality trauma care services (Outcome, 16,250,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 (i) # of trauma centers using trauma registry: 39 (i) # of trauma centers (ii) Percentage point using trauma registry: 39 increase in emergency (ii) Percentage point surgeries within 6 hours increase in emergency of admission in select surgeries within 6 hours of medical admission in select (i) Increase in the college hospitals*: 9.1 medical number of trauma percentage point college hospitals*: 9.1 centers where the increase (with 85% percentage point increase trauma registry is in surgical ED (with 85% surgical ED use - US$35,000 for (i) # of trauma centers admissions)DLI achieved admissions)DLI achieved each additional using trauma registry: 0 (iii) Creation and (iii) Creation and trauma center from ……………….(ii) % of strengthening of strengthening of the previous year surgical emergency emergency departments emergency departments in operating a trauma department admissions in in select medical college select medical college registry up to 14 Group A and B facilities hospitals: emergency hospitals: emergency trauma centers Value who received surgery within department established department established in ………….. (ii) 6 hours of admission in the in 25 MCH centres- DLI 25 MCH centres- DLI Percentage point same institution: 6.7% achieved achieved increase in ……………….(iii) % of IFT (iv) Developing level-1 (iv) Developing level-1 emergency calls as a % of total 108 and level-2 trauma and and level-2 trauma and surgeries within 6 system calls: 41.1% emergency care facilities emergency care facilities hours of admission as part of the regional as part of the regional in select medical trauma and emergency trauma and emergency college hospitals- care system of Tamil care system of Tamil US$461,500 for Nadu: 13 Level-1 trauma Nadu: 13 Level-1 trauma every percentage centres, 29 Level-2 centres, 29 Level-2 point increase up to trauma centres trauma centres 3 percentage points established: DLI established: DLI achieved achieved (v) already achieved (v) already achieved DLRs: Trauma registry DLRs: Trauma registry developed and protocols developed and protocols for IFTs developed for IFTs developed Date -- 31-Mar-2023 10-May-2024 -- Comments ►DLI 5 Increased utilization of reproductive and child health services in priority districts (Outcome, 56,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Value (i) Women receiving full (i) Women receiving full (i) Women receiving full (i) Percentage point ANC: 28.8% ……………… ANC: 74.3% ANC: 74.3% increase in women 5/23/2024 Page 14 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) (ii) Children 12–23 months (ii) Children 12–23 (ii) Children 12–23 months receiving full ANC fully immunized: 57.9% months fully immunized: fully immunized: 91.6% compared to the …………….. (iii) Modern 91.6% (iii) Modern contraception previous survey contraception prev. rate: (iii) Modern contraception prev. rate: 66.8% (with statistical 38.5% prev. rate: 66.8% significance) - Cumulative targets have US$1,600,000 for Definitions: (a) Full ANC Cumulative targets have been achieved. every percentage means at least four ANC been achieved. point increase from visits, at least one tetanus baseline up to 5 toxoid injection, and having percentage points taken IFA tablets or syrup ……………………… for 100 or more days. (b) .. (ii) Percentage Full immunization means point increase in full vaccinations against immunization of tuberculosis, diphtheria, children 12–23 pertussis, tetanus, polio, months compared to and measles the previous survey (with statistical significance) - US$1,600,000 for every percentage point increase from baseline up to 5 percentage points ……………………… ….. (iii) Percentage point increase in modern contraceptive prevalence rate compared to the previous survey (with statistical significance) - US$3,300,000 for every percentage point increase from baseline up to 2 percentage points Date -- 31-Mar-2023 10-May-2024 -- Comments ►DLI 6 Strengthened content, quality, accessibility, and use of data for decision-making (Output, 21,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Value HMIS in place but (i) Detailed Conceptual (i) Detailed Conceptual (i) Population health fragmented across data Model and Operational Model and Operational registry developed streams/ databases Plan developed for a Plan developed for a and rolled out in 1 strengthened HMIS strengthened HMIS district of Tamil covering all data sources, covering all data sources, Nadustate: data users and data data users and data US$15,000,000 channels including channels including integration with electronic integration with electronic medical records and medical records and patient tracking for patient tracking for NCDs: NCDs: Completed Completed (ii) Population (ii) Population health health registry developed registry developed and and rolled out in 1 district 5/23/2024 Page 15 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) rolled out in 1 district of of Tamil Nadu: verification Tamil Nadu: in progress under progress Date -- 31-Mar-2023 10-May-2024 -- Comments ►DLI 7 Strengthened coordination, integration, performance-based management, learning, and other cross-cutting functions for better results (Process, 35,750,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 (i) Operational Research Program call for proposals issued for Year 4. Completed (i) Operational Research (ii) 1 annual call for Program call for proposals research proposals issued for Year 5. issued and selected Completed; however, proposal awarded: Y verification under progress (iii) Program Steering (ii) 1 annual call for (i) Annual call for Committee meeting held research proposals issued research proposals during every month of the and selected proposal issued and selected year: Completed awarded: Y (iii) Program proposal awarded - (iv) Nodal officers Steering Committee US$ designated in each meeting held during every 3,000,000……..(ii) directorates and societies month of the year: Operational plan of under the TNHSRP: Completed (iv) Nodal the environmental Completed officers designated in strategy of the (v)Development of an Value NA each directorates and health sector operational plan for societies under the implemented: environmental strategy of TNHSRP: Completed US$1,250,000…… the health sector (v)Development of an …(iii) Monthly completed and operational plan for meetings of implementation is environmental strategy of Program Steering underway. the health sector Committee (PSC) of (vi) DLRs already completed. (vi) DLRs the Program achieved: TN health already achieved: TN conducted: policy/ strategy, health policy/ strategy, US$2,500,000 guidelines on operational guidelines on operational research program, research program, guidelines on guidelines on professional professional development programs, development programs, and environment strategy. and environment strategy. Date -- 31-Mar-2023 10-May-2024 -- Comments ►DLI 8 Increased transparency and accountability through citizen engagement (voice, agency, and social accountability) (Output, 13,750,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Value NO (i) 79% of districts (i) 63% of districts; (i) At least 40% of (ii) 1 SHA completed verification under progress all districts conducted health 5/23/2024 Page 16 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) (ii) 1 SHA completed; assembly during the verification under progress year - US$3,000,000 ………….. (ii) Tamil Nadu conducted state health assembly during the year - US$250,000 Date -- 31-Mar-2023 10-May-2024 -- Comments 5/23/2024 Page 17 of 17