The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) Morocco Health Reform Program (P179014) MIDDLE EAST AND NORTH AFRICA | Morocco | Health, Nutrition & Population Global Practice | Requesting Unit: MNC01 | Responsible Unit: HMNHN IBRD/IDA | Program-for-Results Financing | FY 2023 | Team Leader(s): Denizhan Duran Seq No: 1 | ARCHIVED on 18-Sep-2023 | ISR57559 | Created by: Mariam William Guirguis on 10-Aug-2023 | Modified by: Mariam William Guirguis on 14-Sep-2023 Program Development Objectives PDO Table Program Development Objective (from Program Appraisal Document) To strengthen institutional capacity and governance for improved provision of quality public health services in the Program Area Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO -- Satisfactory Overall Implementation Progress (IP) -- Satisfactory Implementation Status and Key Decisions The Morocco Health Reform Program was approved by the World Bank Board of Executive Directors on June 15, 2023. The Program is not yet declared effective pending signing of the Legal Agreement between the World Bank and the Government of Morocco. The Program development objective is to support strengthening the institutional capacity and governance for improved provision of quality public health services in the Program Area. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Not P179014 IBRD-95540 USD 450.00 450.00 0.00 0.00 450.00 0% Effective Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date Not P179014 IBRD-95540 15-Jun-2023 -- -- 30-Sep-2028 30-Sep-2028 Effective Program Action Plan Finalization of Program Operations Manual (POM) including: administrative and M&E procedures; E&S management, Action Description complaints and GRM; PAP; results and verification protocol; reports templates, fraud and corruption reporting; Program area details. 9/18/2023 Page 1 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) Source DLI# Responsibility Timing Timing Value Status No later than 4 mon 7 / 15Seq no.: PROGRAM ACTION PLAN Action Description DLI# Timing Timing Value Status Technical MHSP Other Not Yet Due Completion Measurement Finalization of Program Operations Manual (POM) including: administrative and M&E procedths from the Effective Date Completion Measurement POM finalized and receives no-objection by the World Bank Comments The Steering committee (SC) annually and the Technical committe (TC) have been constituted and met to monitor Program implementation progress, and each meeting has been instituted by a report which includes the activities for Action Description the following year. Source DLI# Responsibility Timing Timing Value Status No later than 4 months Technical MHSP Other Not Yet Due after the Effective Date The SC, composed of key MHSP and other stakeholders and the TC, composed of the technical directorates and Completion Measurement other parties have met no later than 4 months after the effective date. The SC meets regularly on annual basis and the TC meets semesterly. Comments Action Description Capacity building in E&S management for all program focal points and stakeholders. Source DLI# Responsibility Timing Timing Value Status Environmental and Social No later than 6 months MHSP Other Not Yet Due Systems from the Effective date Completion Measurement Development and implementation of the training plan based on the E&S Technical Manual Comments 9/18/2023 Page 2 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) Preparation and implementation of an E&S Technical Manual (as part of the POM) which will provide details on the Action Description actions and follow-up to be carried out by the focal points. Source DLI# Responsibility Timing Timing Value Status Environmental and Social No later than 4 months MHSP Other Not Yet Due Systems from the Effective Date Completion Measurement The environmental and social technical manual, including good E&S practices, validated by the World Bank. Comments Action Description Development of new GRM for ESSP rehabilitation works, including grievances from personnel and contractors Source DLI# Responsibility Timing Timing Value Status Environmental and Social No later than 4 months MHSP Other Not Yet Due Systems from the Effective Date Completion Measurement GRM developed and available for personnel and contractors Comments Action Description Appointment of environmental and social (including gender) focal points at regions at MSPS Source DLI# Responsibility Timing Timing Value Status No later than four Environmental and Social MSPS/GST Other months year after the Not Yet Due Systems Effective date Completion Measurement Designation letters of focal points within MSPS Comments Evaluation of the management of liquid effluents of ESSP: Diagnosis of the liquid effluent management system at Action Description ESSP in order to identify ESSP that require an improvement of their liquid sanitation system. Source DLI# Responsibility Timing Timing Value Status Environmental and Social No later than 1 year MHSP Other Not Yet Due Systems from the Effective Date Completion Measurement Evaluation of the management of liquid effluents from healthcare centers Comments Action Description Development and implementation of the training plan on the Environmental and Social Good Practice Guide Source DLI# Responsibility Timing Timing Value Status 9/18/2023 Page 3 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) Environmental and Social No later than 6 months MHSP Other Not Yet Due Systems from the Effective Date - Training module developed Completion Measurement - Training plan developped - Reports on the training carried out Comments Action Description Development of a Communication Plan and Engagement with Stakeholders Source DLI# Responsibility Timing Timing Value Status Environmental and Social No later than 6 months MHSP Other Not Yet Due Systems from the Effective date Development of a plan to identify the key stakeholders involved to strengthen and sustain their engagement Completion Measurement throughout the implementation of the program Comments Action Description Appointment of environmental and social (including gender) focal points at regions at GST Source DLI# Responsibility Timing Timing Value Status Environmental and Social No later than one year MSPS Other Not Yet Due Systems after the Effective date Completion Measurement Designation letters of focal points within GST/regions Comments Action Description Preparation of regional medical and pharmaceutical waste management plans Source DLI# Responsibility Timing Timing Value Status Environmental and Social No later than 2 years MHSP/GST Other Not Yet Due Systems from the Effective Date Completion Measurement Medical and pharmaceutical waste management plans covering the regions targeted by the Program Comments Action Description Ensure that procurement plans are prepared and implemented in accordance with the existing regulations Source DLI# Responsibility Timing Timing Value Status DPRF/DEM/DAMPS/ Fiduciary Systems Recurrent Continuous Not Yet Due GST 9/18/2023 Page 4 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) Annual Procurement plans are published no later than the end of Q1 of the fiscal year and are implemented in Completion Measurement accordance with the existing regulations . Comments Action Description Develop and implement a program to enhance capacity-building on the new procurement decree. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems TGR Due Date 01-Jan-2024 Not Yet Due Completion Measurement A capacity strengthening program on the new procurement decree is prepared and implemented by TGR Comments Action Description Include in the bidding documents an eligibility check clause Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MSPS/GST Other Continious Not Yet Due An eligibility check clause included in the bidding documents and implementing agencies are required to ensure that Completion Measurement any person or entity debarred or suspended by the Bank is not awarded a contract under the Program Comments Action Description Follow up on audits recommendations of the Porgram Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems DPRF and IGM Recurrent Continuous Not Yet Due Completion Measurement Number of audit recommendations implemented and timely reported in the Program activity reports Comments Action Description Set up the internal audit unit in accordance with the regulations in force (new decree) Source DLI# Responsibility Timing Timing Value Status Date of publication of Fiduciary Systems MEF/DPRF Other Not Yet Due the decree Application of the decree and operationalization of the internal audit unit within the ministry (internal audit unit with its Completion Measurement staff; management tools of the function put in place; number of internal audit mission reports; allocated budget etc.) Comments 9/18/2023 Page 5 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) Implement a semi-annual reporting mechanism including (i)Public Procurement: Tenders and procurement-related Action Description complaints; and (ii) Financial Management Source DLI# Responsibility Timing Timing Value Status DEM/DPRF/DAMPS/ Fiduciary Systems Recurrent Semi-Annually Not Yet Due GST Completion Measurement A reporting is done through the minutes of technical committees, on a semi-annual basis Comments Develop in the program operations manual (POM), the tools and procedures for collection, consolidation, reporting, Action Description on fraud and corruption and identify the responsible entity. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems DPRF/IGM Recurrent Semi-Annually Not Yet Due Completion Measurement Number of cases of fraud and corruption systematically reported in Program activity reports Comments Strengthen coordination between implementing entities and develop tools for collecting budget execution and Action Description accounting data at the level of each implementing entity and capacity building actions Source DLI# Responsibility Timing Timing Value Status Six months following Fiduciary Systems DPRF Other Not Yet Due the Effective Date Financial and budgetary information is included in the half-yearly activity report and is considered to be acceptable Completion Measurement and audited financial statements prepared and submitted on time Comments Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate -- Moderate Macroeconomic Substantial -- Substantial Sector Strategies and Policies Substantial -- Substantial Technical Design of Project or Program Moderate -- Moderate Institutional Capacity for Implementation and Substantial -- Substantial Sustainability 9/18/2023 Page 6 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) Fiduciary Substantial -- Substantial Environment and Social Substantial -- Substantial Stakeholders Substantial -- Substantial Other -- -- -- Overall Substantial -- Substantial Results PDO Indicators by Objectives / Outcomes Strengthened organizational and institutional capacity for health system governance IN01332988 ►Strengthened institutional capacity through the new deconcentrated governance system (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Legal framework for the establishment of territorial health groups (GST) established through 100 percent of GST in publication of Framework Program area have Value -- --- Law 06-22. Training established a regional programs for relevant staff health map do not include the current decentralization arrangements. Date 15-Mar-2023 -- 12-Sep-2023 30-Sep-2028 • Health system redesign program entails a substantial shift towards a decentralized governance model, with the introduction of many management, planning, and budgeting tools for GST to fulfill their responsibilities. • This indicator/DLI incentivizes the development of key management inputs, such as executive board, organogram, and status of personnel, as well as key planning tools, such as the regional medical program and the health map. Evidence from other sectors demonstrates challenges in Comments institutionalizing decentralized arrangements, and the DLI will accelerate this implementation. This also implies a substantial need to strengthen the capacity of relevant personnel working in GST, with training serving as the first step for personnel to be able to strengthen institutional capacity. This indicator/DLI also incentivizes the development and implementation of a comprehensive training program for GST, including a focus on planning and implementing interventions within GST to support victims of GBV and to adapt to the health impacts of climate change. Improved availability, motivation and competence of human resources for health IN01332986 ►Health service operationalized to define health worker entitlements and to improve the quality of service delivery (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 100 percent of GST in The distribution of human Program area have resources across regions increased their human and provinces is not resource capacity by equitable, and some Value -- --- 50 percent with provinces do not have respect to identified sufficient staffing of gaps in 2023 to ensure doctors, nurses and an equitable technical health staff distribution, particularly 9/18/2023 Page 7 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) at the level of under- resourced provinces Date 15-Mar-2023 -- 12-Sep-2023 30-Sep-2028 • Human resources for health are inequitably distributed across the regions and provinces, with some areas being critically under-resourced; there are no financial incentives for health workers to enable deployment to hard-to-reach areas or to improve their performance. The operationalization of the health service, through the design of a new payment modality, will allow to improve the motivation and distribution of the health workforce, encouraging deployment in under-resourced regions and provinces through a system of coefficients of medical procedures by regions, including incorporating conditions of distributions of the labor Comments force through a gender lens. • The DLI will incentivize the integration of well-defined measures on quality and performance into the payment of health workers, with the intention of motivating health workers to close the know/do gap and to work in hard-to-reach areas, including areas most vulnerable to climate change, leveraging information from the climate health vulnerability assessment to identify climate vulnerable facilities. This will also ensure bringing services closer to the population, with increased availability of health services at the regional level, therefore resulting in a lower carbon footprint for the health sector through reduced mobility to seek health services. Strengthened and reorganized health services IN01332987 ►Quality of care at public hospitals and public PHC facilities evaluated and improved (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 100 percent of GST in Program area have Development of quality produced a quality standards and ongoing evaluation report and Value -- --- quality evaluation of public adopted a quality hospitals. improvement plan for public hospitals and public PHC facilities Date 15-Mar-2023 -- 12-Sep-2023 30-Sep-2028 • Deconcentration provides an opportunity to incentivize and institutionalize quality improvements at the facility level. • This DLI includes a phased approach for the institutionalization of quality evaluations at the GST level, starting with the establishment of a quality assessment structure at the GST level, then the Comments development and adoption of quality evaluation tools for public PHC facilities. The last two annual targets will focus on the development and adoption of a quality evaluation and improvement roadmap, then on the production of a quality evaluation report and adoption of a quality improvement plan for hospitals and public PHC facilities. IN01332989 ►Availability of essential health service package at public PHC facilities (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 72% of public PHC 90% of public PHC facilities in Program area facilities in Program Value -- --- have essential health area have essential service package health service package Date 15-Mar-2023 -- 12-Sep-2023 30-Sep-2028 MHSP has an essential health service package for primary care levels which differs according to the level of the public PHC facility. A survey was conducted by the MSPS among a purposive sample of about 446 PHCs (considered as chief health district or circle) in the Program area, to assess the availability of the essential health services package at the PHC level. This survey captured a range of elements pertaining to Comments structural quality of health facilities, including the availability of staff, availability of medicines, and availability of medical equipment to enable effective screening and treatment of maternal and newborn health conditions, as well as non-communicable diseases. The results of the survey led to the implementation of a series of improvement measures. Intermediate Results Indicators by Results Areas 9/18/2023 Page 8 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) Strengthened organizational and institutional capacity for health system governance IN01332990 ►Exchange and coordination platforms organized between central and regional entities (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 100 percent of GST in Communication focal Program area have points at the regional published a report on health directorate level, key discussion areas Value informal communication -- --- from the platform and networks between the have integrated regions and the central suggestions emerging level from the exchange and coordination platform Date 15-Mar-2023 -- 12-Sep-2023 30-Sep-2028 Given the substantial nature of changes and the increase in the number of stakeholders with the health sector reform, it is essential to institutionalize knowledge exchange and coordination platforms to improve Comments the responsiveness of the health system. • This Indicator/DLI incentivizes the implementation of a systematic platform to facilitate these exchanges, which will provide a crucial platform for change management, citizen engagement, and a modality to institutionalize learning. IN01332992 ►Improved patient satisfaction (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 15 percentage point No systematized tracking increase compared to Value -- --- of patient satisfaction baseline established in year 2 Date 15-Mar-2023 -- 12-Sep-2023 30-Sep-2028 Given the substantial changes expected with the health system redesign program, it is essential to track the feedback from patients. There is currently no systematized modality to regularly track patient feedback. In Comments this context, this indicator measures the establishment of a standardized process to measure patient satisfaction, and its implementation to track improvements as a result of the successful implementation of the reform. Improved availability, motivation and competence of human resources for health IN01332991 ►Update of training curricula for nurses and health technicians to reflect the health system redesign program, with the incorporation of rights to health and gender, including GBV (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 100% of GST in Training curricula not Program area have updated to reflect the implemented the health system redesign Value -- --- updated in-service program with the training curricula for integration of rights to nurses and technical health and gender staff Date 15-Mar-2023 -- 12-Sep-2023 30-Jun-2028 Health system redesign program will entail substantial changes to service delivery, through reorganization of service delivery, definition of pathways, increased autonomy and accountability with performance / quality Comments payments for health workers. In addition, there is a renewed focus on various priority epidemiological conditions, such as chronic diseases and the care of gender-based violence survivors. This necessitates an overhaul of pre-service training curricula at ISPITS and in-service training curricula at the GST level, which 9/18/2023 Page 9 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) will contribute to improved quality of service delivery. This indicator captures the updates to these training curricula as well as their implementation for pre-service training at ISPITS, and in-service training at the GST level, with the incorporation of rights to health and gender, including gender-based violence. IN01332993 ►Improved training capacity for ISPITS (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7,500.00 -- 7,500.00 11,600.00 Date 15-Mar-2023 -- 12-Sep-2023 30-Sep-2028 • The Ministry of Health and Social Protection developed an action plan to train of 64,000 nurses, and this Comments expansion in capacity will be supported by the DLI, which includes annual cumulative end targets of 11,600 for the number of enrollees from ISPITS from a baseline of 7,500 ISPITS enrolled. Strengthened and reorganized health services IN01332994 ►Strengthened epidemiological surveillance capacity including for climate change related health issues (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 100 percent of GST in Program area published A study was conducted to epidemiological Value assess epidemiological -- --- bulletins based on surveillance capabilities approved revised surveillance regulations Date 15-Mar-2023 -- 12-Sep-2023 30-Sep-2028 • Epidemiological surveillance capacity is a key health system function, especially as the health risks from climate change become more imminent; MHSP is in the process of restructuring epidemiological surveillance capacity. • This indicator/DLI incentivizes the government to implement this restructuring process to strengthen surveillance capacity, starting with the definition of a roadmap in the first year, Comments followed by the adoption and validation of the structure of the epidemiological surveillance in the second year, and the update and adoption of regulations in the third year. This indicator/DLI has a focus on climate change adaptation and will include the inclusion of climate change related diseases in the updated list of notifiable diseases in the third year. The fourth and fifth years will ensure that GSTs publish epidemiological bulletins based on new regulations. IN01332995 ►Strengthening of the governance and organization of preventive health services for screening for congenital hypothyroidism (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Screening for Screening for congenital congenital hypothyroidism available hypothyroidism Value in 56 percent of -- --- available in 100 GST/regions in Program percent of area GST/regions in Program area Date 15-Mar-2023 -- 12-Sep-2023 30-Sep-2028 Within the framework of the government’s strategy to strengthen prevention of health services, the governance and organization of preventive services for congenital hypothyrodism (CH) is a signiifcant priority, and strengthened prevention for this condition is a cost-effective way to reduce the burden of Comments physical and mental health conditions. This indicator captures the progressive implementation of the government’s strategy to reduce this burden and also provide a blueprint for the prevention of other priority health conditions, serving as a proxy for the government's scale up of preventive services through the health system redesign program. IN01332996 9/18/2023 Page 10 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) ►Maternal and neonatal death surveillance, audit, and response system scaled up (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 50% of GST in 70% of GST in Program Program area have Value area use the maternal -- --- completed maternal death surveillance system and neonatal death audit reports Date 15-Mar-2023 -- 12-Sep-2023 30-Sep-2028 Maternal and neonatal mortality in Morocco continues to remain high, and maternal and neonatal death surveillance, audit, and response system is critical to decrease the number of avoidable deaths. • This Comments Indicator incentivizes the accelerated scale-up of the maternal surveillance system in the first year, the integration of neonatal death audit in the second and third years, and the development and implementation of recommendations to reduce maternal and neonatal deaths in the fourth and fifth years. IN01332997 ►Percentage of pregnant women in Program area who have completed 4 antenatal care visits (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Rural: 38.5% (2018) Rural: 47% Urban: 65.6% (2018) Urban: 70% Value -- --- Date 15-Mar-2023 -- 12-Sep-2023 30-Sep-2028 There is a substantial gender gap between the coverage of the required four antenatal care visits between women living in urban and rural areas, which is a key health indicator for maternal health. Most women end Comments up seeking care antenatal care services at the PHC level, and the health system redesign is expected to increase utilization of these services. IN01332998 Percentage of pregnant women in Program area who have completed 4 antenatal care visits in rural areas (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 38.50 -- --- 47.00 IN01332999 Percentage of pregnant women in Program area who have completed 4 antenatal care visits in urban areas (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 65.60 -- --- 70.00 Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 Strengthened institutional capacity through the new deconcentrated governance system (Process, 75,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) 2028 Legal framework for the establishment of territorial health groups (GST) 100 percent of GST established through in Program area Value -- --- publication of Framework have established a Law 06-22. Training regional health map programs for relevant staff do not include the current 9/18/2023 Page 11 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) decentralization arrangements. Date -- -- 12-Sep-2023 -- Comments ►DLI 2 Health financing system reformed to reflect the context of the reform and improve quality of service delivery (Output, 28,875,000.00, 0%) Baseline Actual (Previous) Actual (Current) 2028 Public hospitals constitute 70 percent of GST 10 percent of Mandatory budgets in Program Value -- --- Health Insurance third party area are from AMO payments payments Date -- -- 12-Sep-2023 -- Comments ►DLI 3 Improved content, quality, accessibility, and use of health data (Output, 37,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) 2028 Publication of an Integrated and digitalized annual health sector health information system report in Program Value deployed at hospitals, and -- --- area on health deployment began in PHC programs with an centers emphasis on quality indicators Date -- -- 12-Sep-2023 -- Comments ►DLI 4 Exchange and coordination platforms organized between central and regional entities (Output, 30,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) 2028 100 percent of GST in Program area have published a Communication focal points report on key at the regional health discussion areas directorate level, informal from the platform Value -- --- communication networks and have between the regions and incorporated the central level suggestions from the exchange and coordination platform Date -- -- 12-Sep-2023 -- Comments 9/18/2023 Page 12 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) ►DLI 5 Health service operationalized to define health worker entitlements and to improve the quality of service delivery (Process, 45,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) 2028 100 percent of GST in Program area The distribution of human have increased their resources across regions human resource and provinces is not capacity by 50% equitable, and some relative to the gap Value -- --- provinces do not have identified in 2023 to sufficient staffing of ensure equitable doctors, nurses and distribution, technical health staff particularly for understaffed provinces Date -- -- 12-Sep-2023 -- Comments ►DLI 6 Improved training capacity at ISPITS (Output, 45,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) 2028 Value 7,500.00 -- 7,500.00 11,600.00 Date -- -- 12-Sep-2023 -- Comments ►DLI 7 Number of public PHC facilities in Program area rehabilitated to comply with energy and thermal efficiency standards to address climate vulnerabilities (Output, 75,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) 2028 Value 0.00 -- 0.00 395.00 Date -- -- 12-Sep-2023 -- Comments ►DLI 8 Quality of care at public hospitals and public PHC facilities evaluated and improved (Process, 45,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) 2028 Value Development of quality -- --- 100 percent of GST standards and ongoing in Program area quality evaluation of public have produced a hospitals quality evaluation report and adopted a quality improvement plan for public hospitals 9/18/2023 Page 13 of 14 The World Bank Implementation Status & Results Report Morocco Health Reform Program (P179014) and public PHC facilities Date -- -- 12-Sep-2023 -- Comments ►DLI 9 Strengthened epidemiological surveillance capacity including for climate change related health issues (Output, 67,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) 2028 100 percent of GST in Program area published A study was conducted to epidemiological Value assess epidemiological -- --- bulletins based on surveillance capabilities approved revised surveillance regulations Date -- -- 12-Sep-2023 -- Comments 9/18/2023 Page 14 of 14