The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Comprehensive Approach to Health System Strengthening (P166013) EASTERN AND SOUTHERN AFRICA | Comoros | IBRD/IDA | Investment Project Financing (IPF) | FY 2020 | Seq No: 10 | Archived on 10-Jun-2024 | ISR00712 Implementing Agencies: MINISTRY OF HEALTH, SOLIDARITY, SOCIAL PROTECTION AND GENDER PROMOTION 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 01-Jul-2019) (i) To improve utilization of quality PHC and (ii) strengthen capacity of institutions which are critical to quality PHC Has the Development Objective been changed since Board Approval of the Project Objective? No 2. COMPONENTS Name Improving Primary Health Care Infrastructure, Workforce and Service Delivery Platforms:(Cost 23,000,000.00) Strengthening institutions and governance which are critical to (i) quality PHC and (ii) response to disease outbreaks:(Cost 3,600,000.00) Citizen Engagement and Empowerment, Project Management, Monitoring and Evaluation,:(Cost 3,800,000.00) Contingent Emergency Response Component:(Cost 4,600,000.00) 3. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Moderately Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Jun 10, 2024 Page 1 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) 4. KEY ISSUES & STATUS 4.1 Implementation Status and Key Decisions Overall, the PDO indicators have been making sound progress towards reaching the end targets. To date, 167,436 people have received essential health, nutrition and population services, approaching the end target of 199,263. 173 community health sites are functional, and 78 out of the 80 targeted primary health care facilities are covered by the performance- based financing (PBF) scheme, both for quantity and quality. Although the indicator related to the certification of health facilities is still at 0, the process is advancing well despite the constraints caused by the cholera outbreak. To date, the project has achieved its coverage objective, both at the facility and community level. PBF, community health platform, rehabilitations and equipment are now in place and serving the intended beneficiaries. 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Last Approved Rating Risk Category Approval Package - ISR Seq. 09 - 07 Dec Proposed Rating 02 Jul 2019 2023 Political and Governance High Moderate Moderate Macroeconomic Substantial Substantial Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and High High Substantial Sustainability Fiduciary High Substantial Substantial Environment and Social Moderate Moderate Low Stakeholders Moderate Moderate Moderate Overall High Moderate Moderate Jun 10, 2024 Page 2 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes (i) Improve utilization of quality PHC Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year PHC facilities with 0.00 Dec/2017 0.00 01-Dec-2023 40.00 Sept/2025 accreditation level 2 above as Comments on The preparatory activities are advancing well despite the constraints caused by the cholera per the quality assurance achieving targets outbreak. The first certifications are scheduled by end September 2024. program (Number) PHC facilities participating in 0.00 Dec/2017 64.00 01-Dec-2023 80.00 Sept/2025 the PBF scheme supported by the project which reimburses for both quantity and quality of service (Number) People who have received 0.00 Dec/2017 167,436.00 24-Apr-2024 167,436.00 24-Apr-2024 199,263.00 Sept/2025 essential health, nutrition, and population (HNP) services (Number) Of which female 0.00 Dec/2017 133,891.00 24-Apr-2024 133,891.00 24-Apr-2024 161,029.00 Sept/2025 (Number) Number of children 0.00 Dec/2017 51,733.00 01-Dec-2023 70,263.00 Sept/2025 immunized (Number) Number of women and 0.00 Dec/2017 40,814.00 24-Apr-2024 40,814.00 24-Apr-2024 59,000.00 Sept/2025 children who have received basic nutrition services (Number) Jun 10, 2024 Page 3 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Number of deliveries 0.00 Dec/2017 56,267.00 24-Apr-2024 56,267.00 24-Apr-2024 70,000.00 Sept/2025 attended by skilled health personnel (Number) Functional community health 69.00 Oct/2019 173.00 01-Dec-2023 172.00 Sept/2025 sites (Number) (iii) Provide immediate and effective response to an Eligible Crisis or Emergency Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Percentage of identified close 0.00 May/2020 100.00 01-Dec-2023 80.00 Dec/2022 contacts of confirmed COVID- Comments on Achieved, and no update for this indicator. It is not tracked for the year 2022 and beyond. 19 cases investigated based achieving targets on national guidelines (Percentage) 6.2 Intermediate Results Indicators by Components Improving Primary Health Care Infrastructure, Workforce and Service Delivery Platforms Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year PHC facilities renovated 0.00 Dec/2019 95.00 27-Apr-2024 95.00 27-Apr-2024 100.00 Sept/2025 (minor renovations) and/or equipped among the PHC structures in need of these renovations and/or equipment (percentage) (Percentage) Jun 10, 2024 Page 4 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Number of PHC health 0.00 Dec/2019 244.00 01-Dec-2023 500.00 Sept/2025 workers receiving annual CME (Number) Of which female 0.00 Dec/2019 162.00 01-Dec-2023 332.00 Sept/2025 (Number) Revision of the pre-service No Dec/2019 No 27-Apr-2024 No 27-Apr-2024 Yes Sept/2025 nurse training curriculum to Comments on The final version of the curriculum is available and is pending final approval from the MoH. make it competency-based achieving targets (Yes/No) Recipients of scholarships for 0.00 Dec/2019 33.00 01-Dec-2023 35.00 Sept/2025 pre-service training in selected clinical disciplines, public health and health management (Number) 0.00 Dec/2019 305.00 27-Apr-2024 305.00 27-Apr-2024 516.00 Sept/2025 Community health workers Comments on More CHW will be trained over the next 6 months, which will enable the target to be reached. trained to provide health and achieving targets These are complimentary CHW. nutrition services (Number) Of which female 0.00 Dec/2019 197.00 01-Dec-2023 333.00 Sept/2025 (Number) PHC facilities with at least 0.00 Dec/2019 0.00 01-Dec-2023 60.00 Sept/2025 one quality improvement Comments on This activity is linked to the evaluations under FBP and certification which is expected to start initiative with the team achieving targets on January 2024. An increase is expected in before September 2024. based problem solving approach (Number) Functional Emergency 0.00 Dec/2017 0.00 27-Apr-2024 0.00 27-Apr-2024 5.00 Sept/2025 Medical Transportation with Comments on The acquisition of the equipment to enable the functionality of the hotline is under way a dedicated hotline on each achieving targets island (Number) Strengthening institutions and governance which are critical to (i) quality PHC and (ii) response to disease outbreaks Jun 10, 2024 Page 5 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year National Health Strategies 0.00 Jun/2019 3.00 01-Dec-2023 3.00 Sept/2025 and Plans adopted (Quality of Care, NCDs, Human Resources for Health) (number) (Number) PHC health workers 53.00 Dec/2019 64.00 27-Apr-2024 64.00 27-Apr-2024 100.00 Sept/2025 benefiting from annual clinical mentorship and/or coaching (Number) PHC facilities self-monitoring 0.00 Dec/2019 0.00 27-Apr-2024 0.00 27-Apr-2024 50.00 Sept/2025 a set of quality of care Comments on This activity is linked to the evaluations under FBP and certification which is expected to start indicator quarterly for quality achieving targets on January 2024. An increase is expected in before September 2024. improvement (Number) Membership of health 0.00 Dec/2017 310.00 27-Apr-2024 310.00 27-Apr-2024 100.00 Sept/2025 professional associations (Number) Citizen Engagement and Empowerment, Project Management, Monitoring and Evaluation, Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Primary health care facilities 0.00 Dec/2019 42.00 27-Apr-2024 42.00 27-Apr-2024 70.00 Sept/2025 submitting monthly report Comments on An action plan and a coordination framework have been established to increase performance according to national achieving targets guidelines (Percentage) Annual District and National 0.00 Oct/2019 50.00 01-Dec-2023 86.00 Sept/2025 Health Assemblies Comments on The assemblies take place at the end of the calendar year. An increase is expected by end (Number) achieving targets 2024. Jun 10, 2024 Page 6 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Operational hotline for No Dec/2019 Yes 27-Apr-2024 Yes 27-Apr-2024 Yes Sept/2025 patient complaints and feedbacks (Yes/No) Patient associations/support 0.00 Dec/2019 2.00 27-Apr-2024 2.00 27-Apr-2024 4.00 Sept/2025 groups established (diabetes, hypertension, chronic lung diseases, cancer) (Number) Nationally representative 0.00 Dec/2019 1.00 01-Dec-2023 2.00 Sept/2025 patient experience surveys Comments on The next survey is planned in Q4 2024. conducted (Number) achieving targets Complaints for grievances 0.00 Dec/2017 100.00 01-Dec-2023 75.00 Sept/2025 timely addressed (Percentage) Contingent Emergency Response Component Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Emergency Dec/2019 Yes 11-May-2022 Yes Jun/2020 Emergency Action Plan Action Plan validated (Text) prepared Number of designated 0.00 May/2020 3.00 11-May-2022 3.00 08-May-2022 2.00 Dec/2022 GeneXpert center with SARS- CoV-2 diagnostic capacity (Number) Number of designated health 0.00 May/2020 3.00 11-May-2022 3.00 Dec/2022 facilities with COVID-19 case management capacity (Number) Jun 10, 2024 Page 7 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) 7. DATA ON FINANCIAL PERFORMANCE 7.1 Cumulative Disbursements 7.2 Disbursements (by loan) Loan/Credit/TF Status Original Revised Cancelled Disbursed Undisbursed % Disbursed IDA-D7030 Effective 2.50 2.50 0.00 0.00 2.74 0% IDA-67550 Effective 2.50 2.50 0.00 0.00 2.79 0% IDA-D5050 Effective 15.00 15.00 0.00 14.82 0.00 98.78% IDA-64670 Effective 15.00 15.00 0.00 7.41 7.33 49.41% 7.3 Key Dates (by loan) Jun 10, 2024 Page 8 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing IDA-64670 Effective 02-Jul-2019 14-Sept-2019 17-Apr-2020 30-Sept-2024 30-Sept-2025 IDA-67550 Effective 06-Aug-2020 15-Aug-2020 28-Jan-2021 30-Sept-2025 30-Sept-2025 IDA-D5050 Effective 02-Jul-2019 14-Sept-2019 17-Apr-2020 30-Sept-2024 30-Sept-2025 IDA-D7030 Effective 06-Aug-2020 15-Aug-2020 28-Jan-2021 30-Sept-2025 30-Sept-2025 8. KEY DATES Key Events Planned Actual Approval 02-Jul-2019 02-Jul-2019 Effectiveness 31-Oct-2018 17-Apr-2020 Mid-Term Review No. 01 15-Feb-2023 13-Feb-2023 Operation Closing/Cancellation 30-Sept-2025 9. RESTRUCTURING HISTORY Restructuring Level 2 Approved on 09-Oct-2023 10. ASSOCIATED OPERATION(S) There are no associated operations Jun 10, 2024 Page 9 of 9