The World Bank Implementation Status & Results Report Modernization and Improvement of Rehabilitation Services Project (P180306) Modernization and Improvement of Rehabilitation Services Project (P180306) EUROPE AND CENTRAL ASIA | Moldova | IBRD/IDA | Investment Project Financing (IPF) | FY 2024 | Seq No: 1 | Archived on 30-May-2024 | ISR00151 Implementing Agencies: Ministry of Health 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 04-Mar-2024) The PDO is to (i) strengthen noncommunicable disease care by improving prevention and rehabilitation services, with a focus on stroke and heart attacks, at all levels of the health system, and (ii) in case of an Eligible Crisis or Emergency, respond promptly and effectively to it. Has the Development Objective been changed since Board Approval of the Project Objective? No 2. COMPONENTS Name Component 1: Integrated care at the hospital level for NCD patients:(Cost 31,250,000.00) Component 2: Integrated prevention and rehabilitation services at the primary care and population-level:(Cost 12,250,000.00) Component 3: Pandemic preparedness:(Cost 5,612,000.00) Component 4: Project management:(Cost 2,000,000.00) Component 5: Contingent Emergency Response Component:(Cost 0.00) 3. OVERALL RATINGS Name Current Progress towards achievement of PDO Satisfactory Overall Implementation Progress (IP) Satisfactory Overall Risk Rating Moderate May 30, 2024 Page 1 of 9 The World Bank Implementation Status & Results Report Modernization and Improvement of Rehabilitation Services Project (P180306) 4. KEY ISSUES & STATUS 4.1 Implementation Status and Key Decisions On March 5, 2024, the World Bank Board approved funding of Euro 36.2 million (US$40 million equivalent) for the Modernization and Improvement of Rehabilitation Services Project, which is expected to be signed by the end of June 2024. The effectiveness conditions, including the formal adoption of the Project Operations Manual (POM), are expected to be met by August 31, 2024, to ensure the timely initiation of the Project. 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Risk Category Approval Package - 05 Mar Proposed Rating 2024 Political and Governance Substantial Substantial Macroeconomic Substantial Substantial Sector Strategies and Policies Moderate Moderate Technical Design of Project or Program Moderate Moderate Institutional Capacity for Implementation and Moderate Moderate Sustainability Fiduciary Moderate Moderate Environment and Social Moderate Moderate Stakeholders Moderate Moderate Overall Moderate Moderate May 30, 2024 Page 2 of 9 The World Bank Implementation Status & Results Report Modernization and Improvement of Rehabilitation Services Project (P180306) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes PDO Indicator 1: NCD prevention and management in primary care facilities Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Primary care facilities 0 May/2023 0.00 22-Mar-2024 0.00 22-Mar-2024 70 Dec/2029 following standardized Comments on In the first year of the project, the MoH will define a standardized protocol for screening and protocols and guidelines for achieving targets treatment of diabetes and hypertension in primary care settings. This will include required screening, prevention and tests, guidance on lifestyle, medical history, tobacco use, alcohol consumption, and physical management of hypertension activity. Thereafter, primary care facilities supported by the Project will be required to and diabetes (Percentage) implement the approach. PDO Indicator 2: Timely stroke treatment Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Eligible stroke patients who 31.1 Sept/2022 31.1 22-Mar-2024 31.1 22-Mar-2024 70 Dec/2029 are treated with systemic Comments on Early intervention for stroke patients, especially timely systemic thrombolysis, reduces the risk thrombolysis, within 2 hours, achieving targets of severe stroke outcomes like disability and death. This indicator assesses the project's ability in Project-supported facilities to cut treatment delays, ultimately improving patient outcomes. (Percentage) PDO Indicator 3: Facility-readiness for stroke management Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Stroke patients treated in 0.00 May/2023 0.00 22-Mar-2024 0.00 22-Mar-2024 80.00 Dec/2029 fully equipped, dedicated Comments on This indicator draws on RES-Q data, which showed that, in September 2023, across the stroke units in Project- achieving targets country only 31.1 percent of stroke patients were treated in a stroke unit. By January 2024, May 30, 2024 Page 3 of 9 The World Bank Implementation Status & Results Report Modernization and Improvement of Rehabilitation Services Project (P180306) supported facilities MoH will have identified 4 facilities to be supported by the Project and defined a set of (Percentage) features for a stroke unit (in terms of equipment, staffing and infrastructure) and each stroke bed. PDO Indicator 4: Restorative rehabilitation for stroke and cardiac care Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Stroke and cardiac patients 0.00 May/2023 0.00 22-Mar-2024 0.00 22-Mar-2024 75.00 Dec/2029 treated in Project-supported Comments on This indicator responds to MoH and WHO assessments that there is a large unmet need for facilities who received achieving targets rehabilitation services, specifically, restorative rehabilitation in post-acute settings, to limit restorative rehabilitation long-term disability. By January 2024, MoH will define a package of services for restorative services (Percentage) rehabilitation and the Project will support implementation in up to 4 facilities. (Percentage) 6.2 Intermediate Results Indicators by Components Component 1: Integrated care at the hospital level for NCD patients Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Hospitalized stroke patients 64.7 Sept/2022 64.7 22-Mar-2024 64.7 22-Mar-2024 95.00 Dec/2029 recommended to a smoking Comments on This draws on RES-Q data that showed that, across Moldova, 64.7 percent of smokers were cessation program out of achieving targets referred to a smoking cessation program following a stroke. It refers to the annual figure and smokers in Project-supported will be collected through RES-Q. facilities (Percentage) Patients receiving a 0.00 May/2023 0.00 22-Mar-2024 0.00 22-Mar-2024 80.00 Dec/2029 comprehensive rehabilitation Comments on This indicator will first require the MoH and CNAM, by January 2024, to define an assessment and discharge achieving targets interdisciplinary package of services and the activities that are part of a comprehensive plan following a stroke or rehabilitation assessment in a post-acute setting following a stroke or heart attack. heart attack in Project- Thereafter, the indicator will track the number of patients who receive a rehabilitation May 30, 2024 Page 4 of 9 The World Bank Implementation Status & Results Report Modernization and Improvement of Rehabilitation Services Project (P180306) supported facilities services assessment and a discharge plan that provides details on future care, the integration (Percentage) of services across health and social services and guidance on secondary prevention. Health care facilities with 0.00 May/2023 0.00 22-Mar-2024 0.00 22-Mar-2024 4.00 Dec/2029 accessibility modifications Comments on The 2023 Service Delivery Indicator Survey identified that only 30 percent of primary health enabling access for patients achieving targets care facilities had adequate infrastructure to support the accessibility of the facility to patients with disabilities in Project- with different needs. Therefore, this indicator will track the implementation of functioning supported facilities ramps, lifts, tactile flooring, assistive technologies for visually-impaired patients, mobility- (Number) accessible toilets and bars and grab handles for the prevention of falls. Component 2: Integrated prevention and rehabilitation services at the primary care and population-level Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Awareness activities 0 Aug/2023 0.00 22-Mar-2024 0.00 22-Mar-2024 5 Dec/2029 targetting men and women Comments on This indicator focuses on the MoH's assessment that more can be done to inform the general on primary and secondary achieving targets population about actions that can be taken to address NCDs through health literacy prevention of NCDs campaigns, engagement in schools, mass media campaigns and materials in health care (disaggregated by gender) facilities. (Number) Female - 0, Oct/2023 Female - 0, 22-Mar-2024 Female - 0, 22-Mar-2024 Female - 200, Dec/2029 Primary care providers Male - 0 Male - 0 Male - 0 Male - 100 trained in NCD management Comments on This indicator seeks to assess the preparedness of the primary care workforce to address the and rehabilitation care achieving targets growing burden of NCDs. By disaggregating the data by gender, this indicator allows for the (disaggregated by gender) evaluation of gender equity in training opportunities, ensuring that both male and female (Number) healthcare providers have equal access to NCD management and rehabilitation care education. Female primary care 0 0.00 0.00 200 providers trained in NCD management and rehabilitation care (Number) May 30, 2024 Page 5 of 9 The World Bank Implementation Status & Results Report Modernization and Improvement of Rehabilitation Services Project (P180306) Male primary care 0 0.00 0.00 100 providers trained in NCD management and rehabilitation care (Number) Female - 9%, Feb/2022 Female 15%, Dec/2029 Hypertensive men and Male 7% Male 15% women whose hypertension Comments on The 2022 STEPs survey identified that 16.1 percent of women and 10.7 percent of men were is adequately controlled achieving targets taking antihypertensive medication and had their blood pressure under control, a gap of 5.4 (disaggregated by gender) percent. This indicator will track overall improvements in hypertension control and a track (Percentage) reductions in the gender gap as a result of improved programming in primary health care settings. Hypertensive men 7 7 7 15 whose hypertension is adequately controlled (Percentage) Hypertensive women 9 9 9 15 whose hypertension is adequately controlled (Percentage) Component 3: Pandemic preparedness Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 0 Oct/2023 0.00 22-Mar-2024 0.00 22-Mar-2024 4 Dec/2027 Public health centers Comments on The number of public health centers that have been renovated to a functional standard, in renovated (Number) achieving targets preparation for the pandemic response. 0 Oct/2023 0.00 22-Mar-2024 0.00 22-Mar-2024 3 Dec/2027 May 30, 2024 Page 6 of 9 The World Bank Implementation Status & Results Report Modernization and Improvement of Rehabilitation Services Project (P180306) Public health laboratories Comments on The establishment of public health laboratories with diagnostic equipment, test kits, and equipped with diagnostic achieving targets reagents such that they can be functional in providing surveillance and disease monitoring in equipment, test kits, and the event of a pandemic. reagents (Number) Component 4: Project management Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Grievances submitted to the 0.00 May/2023 0.00 22-Mar-2024 0.00 22-Mar-2024 100.00 Dec/2029 Project and addressed within Comments on The timely handling of grievances received through the grievance redress mechanism stipulated time achieving targets (Percentage) 0.00 May/2023 0.00 22-Mar-2024 0.00 22-Mar-2024 85.00 Dec/2029 Comments on This indicator will track the satisfaction of beneficiaries, through an anonymous third-party Beneficiaries satisfied with achieving targets survey, to assess the quality of services. The survey will use a variety of indicators covering the services provided as part of quality of services and equipment, the proficiency of healthcare staff, patient perceptions on the Project (Percentage) the timeliness of care, patient perceptions on follow-up, information shared and prevention mechanisms. The findings of these surveys will be discussed with healthcare facilities and lessons learned will be integrated into future activities. Healthcare workers who are 0.00 May/2023 0.00 22-Mar-2024 0.00 22-Mar-2024 85.00 Dec/2029 satisfied with Project-related Comments on This indicator will track the satisfaction of healthcare workers who receive training related to trainings (Number) achieving targets rehabilitation services. May 30, 2024 Page 7 of 9 The World Bank Implementation Status & Results Report Modernization and Improvement of Rehabilitation Services Project (P180306) 7. DATA ON FINANCIAL PERFORMANCE 7.1 Cumulative Disbursements 7.2 Disbursements (by loan) Loan/Credit/TF Status Original Revised Cancelled Disbursed Undisbursed % Disbursed Not IBRD-96460 40.00 40.00 0.00 0.00 40.00 0% Effective 7.3 Key Dates (by loan) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing Not IBRD-96460 05-Mar-2024 31-Dec-2029 31-Dec-2029 Effective May 30, 2024 Page 8 of 9 The World Bank Implementation Status & Results Report Modernization and Improvement of Rehabilitation Services Project (P180306) 8. KEY DATES Key Events Planned Actual Approval 05-Mar-2024 05-Mar-2024 Effectiveness 30-Aug-2024 Mid-Term Review No. 01 15-Mar-2027 Operation Closing/Cancellation 31-Dec-2029 9. RESTRUCTURING HISTORY 10. ASSOCIATED OPERATION(S) There are no associated operations May 30, 2024 Page 9 of 9