The World Bank Implementation Status & Results Report Paraguay Public Health Sector Strengthening (P167996) Paraguay Public Health Sector Strengthening (P167996) LATIN AMERICA AND CARIBBEAN | Paraguay | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2019 | Seq No: 10 | ARCHIVED on 26-Oct-2023 | ISR58097 | Implementing Agencies: Ministry of Public Health and Social Welfare, Republic of Paraguay Key Dates Key Project Dates Bank Approval Date: 28-May-2019 Effectiveness Date: 26-May-2020 Planned Mid Term Review Date: 27-Mar-2023 Actual Mid-Term Review Date: 27-Mar-2023 Original Closing Date: 31-Dec-2024 Revised Closing Date: 31-Dec-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The objectives of this Project are to: (i) strengthen the public primary health care micro-networks; and (ii) expand access to quality primary health care services for the population covered by the Ministry of Public Health and Social Welfare (MSPBS). Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) The objectives of this Project are to: (i) strengthen the public primary health care micro-networks; (ii) expand access to quality primary health care services for the population covered by the MSPBS; and (iii) strengthen the national health system to respond to the emergency of the COVID-19 pandemic. Components Table Name Investments to strengthen the service delivery capacity of Public Primary Health Care Micro-Networks:(Cost $52.55 M) Improvements in the access to quality health services through priority Integrated Care Sets:(Cost $8.33 M) Project Administration and Implementation Support:(Cost $2.83 M) Emergency Response to COVID-19:(Cost $51.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Unsatisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The PY Public Health Sector Strengthening Project was approved on May 28, 2019, and declared effective on May 26, 2020. The Project objectives are to (i) strengthen the public primary health care micro-networks; (ii) expand access to quality primary health care services for the population 10/26/2023 Page 1 of 8 The World Bank Implementation Status & Results Report Paraguay Public Health Sector Strengthening (P167996) covered by the MSPBS; and (iii) strengthen the national health system to respond to the emergency of the COVID-19 pandemic. The Project was restructured in June 2021 to reallocate US$51 million of the US$115 million loan proceeds to support the Government of Paraguay to respond to the COVID-19 emergency. As of October 2023, the Project has disbursed US$49.28 million (42.85%). On October 10, 2023, the first fully equipped facility was inaugurated, with additional facilities expected to be inaugurated before the end of the calendar year. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic Low Low Low Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary High Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other -- -- -- Overall High Substantial Substantial Results PDO Indicators by Objectives / Outcomes Strengthening the primary public health care micro-networks IN01348961 ►Number of new public primary health care micro-networks established that report performance (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 127.00 Date 31-Dec-2018 31-Dec-2022 31-Dec-2022 31-Dec-2024 In the last measurement submitted by the PIU, the indicator does not meet the requirements requested in Comments: the operational definition of the indicator and therefore cannot be reported. IN01348965 ►Number of FHCCs operating according to the national standards (Number, Custom) 10/26/2023 Page 2 of 8 The World Bank Implementation Status & Results Report Paraguay Public Health Sector Strengthening (P167996) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 187.00 Date 31-Dec-2018 31-Dec-2022 30-Jun-2023 31-Dec-2024 The performance of this indicator is expected to improve in the next semester in line with advances in the Comments: implementation of Component 1 activities. Expanding access for the population covered by the MSPBS IN01348962 ►Percentage of population with access to PHC through the FHCCs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.00 37.00 37.00 37.00 Date 31-Dec-2018 31-Dec-2022 30-Jun-2023 31-Dec-2024 End target surpassed. Target is being revised in light of the assessment that is being carried out by the Comments: PIU. Improving quality primary health care services IN01348880 ►Percentage of pregnant women with early prenatal checkups (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 31.00 65.00 65.00 56.00 Date 31-Dec-2017 31-Dec-2022 31-Dec-2022 31-Dec-2024 End target surpassed. Target and operational definition are being revised in light of the assessment that is Comments: being carried out by the PIU. IN01348964 ►Percentage of patients diagnosed with hypertension. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 10.00 10.00 16.00 Date 31-Dec-2019 31-Dec-2022 30-Dec-2022 31-Dec-2024 Target and operational definition are being revised in light of the assessment that is being carried out by Comments: the PIU. IN01348966 Percentage of women diagnosed with hypertension. (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 13.00 13.00 16.00 10/26/2023 Page 3 of 8 The World Bank Implementation Status & Results Report Paraguay Public Health Sector Strengthening (P167996) Date 31-Dec-2019 31-Dec-2022 31-Dec-2022 31-Dec-2024 IN01348967 Percentage of men diagnosed with hypertension. (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 6.00 6.00 16.00 Date 31-Dec-2019 31-Dec-2022 31-Dec-2022 31-Dec-2024 IN01348968 ►Percentage of TB cases diagnosed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 98.00 98.00 86.00 Date 31-Dec-2017 31-Dec-2022 31-Dec-2022 31-Dec-2024 End target surpassed. Target and operational definition are being revised in light of the assessment that is Comments: being carried out by the PIU. Strengthen the national health system to respond to the emergency of the COVID-19 pandemic IN01348963 ►Percentage of people suspected of having COVID-19 that are reported and tested per approved protocols. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 97.50 96.00 100.00 85.00 Date 31-Mar-2021 31-Dec-2022 30-Jun-2023 31-Dec-2024 End target surpassed. Comments: Intermediate Results Indicators by Components Investments to strengthen the service delivery capacity of Public Primary Health Care Micro Networks IN01348969 ►Number of new FHCCs built (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 152.00 Date 31-Dec-2018 31-Dec-2022 30-Jun-2023 31-Dec-2024 The performance of this indicator is expected to improve in the next semester in line with advances in the Comments: implementation of Component 1 activities related to construction of new health facilities. IN01348972 ►Number of health staff trained (Number, Custom) 10/26/2023 Page 4 of 8 The World Bank Implementation Status & Results Report Paraguay Public Health Sector Strengthening (P167996) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2,500.00 Date 31-Dec-2018 31-Dec-2022 30-Jun-2023 31-Dec-2024 The performance of this indicator is expected to improve in the next semester in line with advances in the Comments: implementation of Component 1 activities. IN01348975 ►Number of Clinical Practice Guidelines revised (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 9.00 Date 31-Dec-2018 31-Dec-2022 30-Jun-2023 31-Dec-2024 The performance of this indicator is expected to improve in the next semester in line with advances in the Comments: implementation of Component 1 activities related to construction of new health facilities. IN01348977 ►Percentage of population assigned to a FHCC with patient-level information in a centralized database (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 16.00 23.00 70.00 Date 31-Dec-2018 31-Dec-2022 30-Jun-2023 31-Dec-2024 IN01348979 ►Health Information System for medicine stock control developed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 12-Mar-2019 31-Dec-2022 30-Jun-2023 31-Dec-2024 Improvements in the access to quality health services through priority Integrated Care Sets IN01348970 ►Percentage of LHCs with Results Management Agreements signed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 38.00 25.00 35.00 Date 31-Dec-2018 31-Dec-2022 30-Jun-2023 31-Dec-2024 Target is being revised considering the assessment that is being carried out by the PIU. Comments: IN01348973 ►Percentage of FHCCs with work program agreed with LHC (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 10/26/2023 Page 5 of 8 The World Bank Implementation Status & Results Report Paraguay Public Health Sector Strengthening (P167996) Value 0.00 29.00 55.00 35.00 Date 31-Dec-2018 31-Dec-2022 30-Jun-2023 31-Dec-2024 Target and operational definition are being revised by the PIU Comments: IN01348976 ►Percentage of municipalities implementing social accountability actions (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 66.00 66.00 35.00 Date 31-Dec-2018 31-Dec-2022 31-Dec-2022 31-Dec-2024 Target and operational definition are being revised by the PIU Comments: IN01348978 ►Percentage of LHCs that report work progress the MSPBS’s information system. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 35.00 Date 31-Dec-2018 31-Dec-2022 30-Jun-2023 31-Dec-2024 Target and operational definition are being revised by the PIU Comments: IN01348980 ►Number of Progress reports produced by the MSPBS's Health Programs on the ICSs based on the MSPBS’s information system. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 15.00 Date 31-Dec-2018 31-Dec-2022 30-Jun-2023 31-Dec-2024 IN01348981 ►Screening for global health risk (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 15.00 18.00 Date 31-Dec-2017 31-Dec-2022 30-Jun-2023 31-Dec-2024 Target and operational definition are being revised by the PIU Comments: IN01348982 ►Percentage of pregnant women screened for HIV. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 70.00 83.00 83.00 80.00 Date 31-Dec-2019 31-Dec-2022 31-Dec-2022 31-Dec-2024 10/26/2023 Page 6 of 8 The World Bank Implementation Status & Results Report Paraguay Public Health Sector Strengthening (P167996) In the last measurement submitted by the PIU, the indicator does not meet the requirements requested in Comments: the operational definition of the indicator and therefore cannot be reported. IN01348983 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 86,635.00 56,954.00 19,115.00 Date 31-Dec-2017 31-Dec-2022 30-Jun-2023 31-Dec-2024 End target surpassed. Target and operational definition are being revised considering the assessment that Comments: is being carried out by the PIU. IN01348984 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 86,635.00 86,635.00 19,115.00 Date 31-Dec-2017 31-Dec-2022 31-Dec-2022 31-Dec-2024 Emergency Response to COVID-19 IN01348971 ►Percentage of public health facilities strengthened to report, diagnose and/or provide immediate attention to COVID-19 patients by receiving medical/laboratory supplies, and/or medicines. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 90.00 Date 27-May-2021 31-Dec-2022 30-Jun-2023 31-Dec-2024 End target surpassed Comments: IN01348974 ►Percentage of public health facilities that are structurally strengthened by receiving medical equipment. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 90.00 Date 08-Jun-2021 31-Dec-2022 30-Jun-2023 31-Dec-2024 Performance of this indicator is expected to improve in the next semester in light of advances in the Comments: implementation of Component 4 activities. Performance-Based Conditions Data on Financial Performance 10/26/2023 Page 7 of 8 The World Bank Implementation Status & Results Report Paraguay Public Health Sector Strengthening (P167996) Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P167996 IBRD-89630 Effective USD 115.00 115.00 0.00 49.28 65.72 43% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P167996 IBRD-89630 Effective 28-May-2019 03-Jun-2019 26-May-2020 31-Dec-2024 31-Dec-2024 Cumulative Disbursements Restructuring History Level 2 Approved on 28-Jun-2021 Related Project(s) There are no related projects. 10/26/2023 Page 8 of 8