The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) EAST ASIA AND PACIFIC | Papua New Guinea | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 5 | ARCHIVED on 01-Nov-2023 | ISR55880 | Implementing Agencies: Independent State of Papua New Guinea, National Department of Health Key Dates Key Project Dates Bank Approval Date: 22-Apr-2020 Effectiveness Date: 16-Dec-2020 Planned Mid Term Review Date: 25-Nov-2024 Actual Mid-Term Review Date: Original Closing Date: 30-Jun-2026 Revised Closing Date: 30-Jun-2026 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objective is to contribute to increasing the utilization of quality essential health services in Project-supported provinces of the Recipient. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Increase service delivery readiness and community-based service delivery:(Cost $12.40 M) Component 2: Improve frontline service delivery performance:(Cost $14.60 M) Component 3: Project management:(Cost $3.00 M) Component 4: Contingent emergency response Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Unsatisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions This is an interim update on Project Status. The Project became effective in December 2020. Despite challenges over the last few years, the Government of Papua New Guinea (GoPNG) remains committed to achieving the Project Development Objectives and the National Department of Health (NDoH) sees the Project as essential towards achieving their national health plan. The GoPNG has requested and the Bank has processed a request to restructure the Project to ease implementation. An amendment to the Financing Agreement was signed by the Bank on October 17, 2023. Key changes included: reallocating about $4.2 million between Component 2 (which reimburses Government against the achievement of key targets) to Component 1 (providing direct investments in primary health care facilities); restructuring the disbursement-linked indicators (DLIs) to revise the timeframe and to accommodate the selection of a new project province to represent the highlands region; simplifying the plan for the Component 1 activities; and revising the Results Framework and targets accordingly. These changes will go into effect upon counter-signature of an amendment of the Financing Agreement by the Government. In the meantime, the DLIs for the Year 1 have been verified by an independent 11/1/2023 Page 1 of 13 The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) verification agent appointed by the NDOH and the request for disbursement of funds to the NDOH and provincial health authorities has been initiated. The Bank's next implementation support mission is scheduled for November-December 2023 and the progress of the project will be more fully reported afterwards. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Low Low Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary High High High Environment and Social Moderate Moderate Moderate Stakeholders High Moderate Moderate Other Low Moderate Moderate Overall High Substantial Substantial Results PDO Indicators by Objectives / Outcomes To improve the quality of essential health services IN01282332 ►Percentage of Eligible Level 2-4 Health Care Facilities in Selected Provinces that have achieved a Minimum Service Quality Score (Text, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target The Integrated Facility (a) For Early Adopter Supervision Checklist Provinces (first two was approved by Selected Provinces): NDOH. East New Integrated Facility Percentage of Eligible Integrated Facility Britain has piloted it Supervision Checklist Level 2-4 Health Care Supervision Checklist to and established a Value was approved by June Facilities in each Early measure quality not baseline. The National 30 and is being piloted in Adopter Province that implemented Health Standards Early Adopter Provinces. have achieved a Division is providing Minimum Service orientation to East Quality Score is at Sepik and Central least thirty percent Provinces. NDOH is 11/1/2023 Page 2 of 13 The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) further making the (30%) over the supervision tool Baseline. available to provinces (b) For Expansion across the country. Provinces (subsequent two Selected Provinces): Percentage of Eligible Level 2-4 Health Care Facilities in each Expansion Province that have achieved a Minimum Service Quality Score is at least twenty percent (20%) over the Baseline. Date 03-Jun-2019 22-Mar-2022 24-Oct-2023 30-Jun-2025 Indicator targets to be revised as part of restructuring package. Comments: IN01282334 Percentage of Eligible Level 2-4 Health Care Facilities that have a Minimum Quality Standards for Enga (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Enga province is no Did no complete the longer part of the Value 0% rollout of the integrated project. This indicator to 30% over baseline supervision checklist. be dropped as part of restructuring package. Date 31-Dec-2021 16-Feb-2023 24-Oct-2023 30-Apr-2026 IN01282336 Percentage of Eligible Level 2-4 Health Care Facilities that have achieved Minimum Service Quality Scores in East New Brittain (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Evaluations using the Evaluations using the integrated supervision integrated supervision Value 70% 30% over baseline checklist will be rolled out checklist will be rolled by June 30, 2023. out by June 30, 2024. Date 31-Dec-2021 16-Feb-2023 24-Oct-2023 30-Apr-2026 To increase the utilization of essential health services IN01282333 ►Percentage increase in the number of Outreach Clinics in Selected Provinces (Text, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target As part of the next Twenty-five percent implementation (25%) increase in the support mission, the number of Outreach Value 0% -36% value will be revised Visits over the (excluding Enga) and Baseline in each Early reflecting the baseline Adopter Province (first 11/1/2023 Page 3 of 13 The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) values of the new two Selected selected provinces. Provinces). Twenty percent (20%) increase in the number of Outreach Visits over the Baseline in each Expansion Province (Subsequent two Selected Provinces). Date 03-Jun-2019 16-Feb-2023 16-Feb-2023 30-Jun-2026 This indicator and target will be revised as part of the Project restructuring. Comments: IN01282335 Percentage increase in the number of Outreach Clinics in Enga (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 25% increase over Value 2,127.00 -57% -57% baseline Date 31-Dec-2021 16-Feb-2023 16-Feb-2023 30-Apr-2026 IN01282337 Percentage increase in the number of Outreach clinics in East New Britain (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1,730.00 -9% -9% 25% over baseline Date 31-Dec-2021 23-Mar-2022 23-Mar-2022 30-Apr-2026 IN01282338 ►Percentage increase in the number of pregnant women who have received four or more antenatal care check-ups (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Thirty percent (30%) increase over baseline for Early Adopter Provinces (first two Selected Provinces) Value Zero percent (0%) -2% -2% Twenty percent (20%) increase over baseline for Expansion Provinces (subsequent two Selected Provinces) Date 31-Dec-2021 16-Feb-2022 16-Feb-2022 30-Jun-2026 This indicator targets will be revised as part of the Project restructuring. Comments: IN01282339 Percentage increase in the number of pregnant women who have received four or more antenatal care check-ups in Enga (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 30% over baseline Value 0% -10% -10% target Date 31-Dec-2021 16-Feb-2023 16-Feb-2023 30-Apr-2026 11/1/2023 Page 4 of 13 The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) IN01282340 Percentage increase in the number of pregnant women who have received four or more antenatal care check-ups in East New Brittain (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0% 3% 3% 30% over baseline Date 31-Dec-2021 16-Feb-2023 16-Feb-2023 30-Apr-2026 IN01282341 ►Percentage increase in the number of children under one year of age who have received DPT-3 (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Thirty percent (30%) increase over baseline for Early Adopter Provinces (first two Selected Provinces) Zero percent (0%) Twenty percent (20%) Value -16% -16% increase over baseline for Expansion Provinces (subsequent two Selected Provinces) Date 31-Dec-2021 16-Feb-2023 16-Feb-2023 30-Jun-2025 This indicator will start to be measured in Year 3. Comments: IN01282342 Percentage increase in the number of children under one year of age who received DPT-3 in Enga (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0% -35% -35% 30% over baseline Date 31-Dec-2021 16-Feb-2023 16-Feb-2023 30-Apr-2026 IN01282343 Percentage increase in the number of children under one year of age who received DPT-3 in East New Brittain (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0% 10% 10% 30% over baseline Date 31-Dec-2021 16-Feb-2023 16-Feb-2023 30-Apr-2026 IN01282344 ►Increase in the number of registered DSTB patients on treatment who have been cured (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Zero percent (0%) Zero percent (0%) Zero percent (0%) Thirty percent (30%) increase over baseline for Early Adopter Provinces (first two Selected Provinces) Twenty percent (20%) increase over baseline 11/1/2023 Page 5 of 13 The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) for Expansion Provinces (subsequent two Selected Provinces) Date 03-Jun-2019 23-Jun-2021 23-Jun-2021 31-Dec-2025 This indicator and target will be revised as part of the Project restructuring. Comments: Intermediate Results Indicators by Components Component 1: Increase service delivery readiness and community-based service delivery IN01282345 ►Number of staff trained in RMNCH-N and PFM under the Project (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target At least 50 % of eligible staff was Value None None None trained in each of the Selected Provinces Date 03-Jun-2019 16-Feb-2023 16-Feb-2023 30-Apr-2026 Comments: Number of staff participating in training IN01282346 ►Innovations for community-based service delivery trialed and scaled up in Selected Provinces (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target One innovation Innovations not Innovations not Innovations not implemented in each Value implemented implemented implemented of the Selected Provinces Date 03-Jun-2019 16-Feb-2023 16-Feb-2023 31-Dec-2025 Contracted NGO or Church service provider implementing community-based service delivery innovation in Comments: line with proposal received IN01282347 ►Percentage of health facilities that have implemented patient feedback mechanisms and responded to issues identified (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Forty percent (40%) increase over baseline for Early Adopter No mechanism No mechanism Provinces (first two To be established in established to collect established to collect Selected Provinces) Year 2 for Early Adopter patient feedback at patient feedback at Thirty percent (30%) Value Provinces and Year 3 for facilities. This will be facilities. This will be increase over baseline Expansion Provinces developed by December developed by for Expansion 31, 2023 December 31, 2023 Provinces (subsequent two Selected Provinces) 11/1/2023 Page 6 of 13 The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) Date 03-Jun-2019 16-Feb-2023 16-Feb-2023 31-Dec-2025 Percentage of health facilities that implemented patient feedback mechanisms and responded to issues identified. The health facilities in the denominator would be level 2-4 facilities in the four selected Early Comments: Adopter and Expansion Provinces. The indicator will be measured through the Integrated Facility Supervision Checklist. Component 2: Improve frontline service delivery performance IN01282348 ►Timely transfer of PHA Performance Funds (Text, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Transfer of PHA Performance Funds from NDOH within 10 working days of the No transfer of PHA No transfer of PHA No transfer of PHA Value date of receipt of an Performance Funds Performance Funds Performance Funds equivalent amount of financing proceeds from the World Bank for such purpose Date 03-Jun-2019 16-Feb-2023 16-Feb-2023 30-Jun-2026 Transfer of PHA Performance Funds from NDOH within 10 working days of the date of receipt of an Comments: equivalent amount of financing proceeds from the World Bank for such purpose IN01282349 ►National Performance Dashboard developed and updated (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target No National Performance No National Performance Dashboard. PHA Dashboard. PHA Dashboard is being Dashboard is being developed based on developed based on National Performance approved performance No National Performance approved performance Dashboard updated Value framework. NDOH can Dashboard framework. NDOH can and available online use the PHA use the PHA Dashboard Dashboard to to aggregate PHA results aggregate PHA results to generate National to generate National Performance Dashboard. Performance Dashboard. Date 03-Jun-2019 16-Mar-2023 16-Mar-2023 31-Dec-2025 Comments: National Performance Dashboard developed, updated annually and published on the NDOH website IN01282350 ►Number of Selected PHAs with a complete Annual Implementation Plan submitted in a timely manner and in accordance with NDOH specifications (Text, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Annual Status of the Annual Status of the Annual Implementation Plans Baseline value to be Implementation Plans in Implementation Plans submitted in a timely determined upon Value Enga and ENB in Enga and ENB manner and to NDOH selection of Provinces completed for Year 1 completed for Year 1 specification in each of DLIs. DLIs. the Selected Provinces 11/1/2023 Page 7 of 13 The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) Date 03-Jun-2019 31-Mar-2022 31-Mar-2022 31-Dec-2025 PHAs in Selected Provinces have correctly prepared an Annual Implementation Plan using NDOH's Comments: template and submitted it to NDOH before the deadline identified in NDOH's budget circular. IN01282351 ►Number of PHA Boards that have used routine data for decision making (Text, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target ENB PHA has a Provincial ENB PHA has a Performance Provincial Performance Dashboard; No PHA Dashboard; No PHA has has a Supportive a Supportive Supervision Supervision Plan. Provincial Plan. Provincial Provincial Performance No PHA has a Provincial Performance Dashboard Performance Dashboard updated Performance Dashboard; Framework approved Dashboard Framework and annual Supportive Value No PHA has a and first iteration of PHA approved and first Supervision Plan Supportive Supervision Dashboard to be iteration of PHA prepared in each Plan completed by April 30, Dashboard to be Selected Province 2023. Supportive completed by April 30, Supervision Plan 2023. Supportive expected to be approved Supervision Plan by June 30, 2023. expected to be approved by June 30, 2023. Date 03-Jun-2019 16-Feb-2023 16-Feb-2023 31-Dec-2025 (i) Province performance dashboard for use by PHA Board developed and updated every six months Comments: using eNHIS data; and (ii) Supportive Supervision Plan to address performance concerns adopted by PHA Board Performance-Based Conditions IN01282352 ►PBC 1 N-DLI 1: Memoranda of Understanding (MoU) signed with up to 4 Selected Provincial Health Authorities (PHAs) (Text, Output, 600,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 2 MOUs signed by June 2 MOUs signed by June Value No MoU signed -- 30, 2021. 30, 2021. Date -- 31-Mar-2022 26-Oct-2023 -- IN01282353 ►PBC 2 N-DLI 2: Integrated Facility Supervision Checklist adopted and updated (Text, Output, 600,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 11/1/2023 Page 8 of 13 The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) No Integrated Facility Integrated Facility Integrated Facility Supervision Checklist Supervision Checklist Supervision Checklist Value -- implemented endorsed by June 30, endorsed by June 30, 2021 2021 Date -- 31-Mar-2022 26-Oct-2023 -- IN01282354 ►PBC 3 Timely transfer of PHA Performance Funds (Text, Output, 1,500,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 No transfer of PHA No transfer of PHA No transfer of PHA Value -- Performance Funds Performance Funds Performance Funds Date -- 16-Feb-2023 26-Oct-2023 -- IN01282355 ►PBC 4 N-DLI 4: Number of Selected Provinces that have achieved all Provincial DLIs. (Text, Output, 1,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 At least one (1) Selected Province has fully achieved DLI Targets of all Value No annual targets met All annual targets met All annual targets met Provincial DLIs for Year 5. Targeted for up to four (4) Selected Provinces. Date -- 31-Mar-2022 26-Oct-2023 -- IN01282356 ►PBC 5 Number of Selected PHAs with a complete Annual Implementation Plan submitted in a timely manner and in accordance with NDOH specifications (Text, Output, 1,600,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Status of the Annual Baseline value to be Status of the Annual Implementation Plans in determined upon selection Implementation Plans in Value Enga and ENB -- of Provinces Enga and ENB completed completed for Year 1 for Year 1 DLIs. DLIs. Date -- 31-Mar-2022 26-Oct-2023 -- IN01282357 11/1/2023 Page 9 of 13 The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) ►PBC 6 Percentage of Eligible Level 2-4 Health Care Facilities in Selected Provinces that have achieved a Minimum Service Quality Score (Text, Output, 2,100,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Integrated Facility Integrated Facility Integrated Facility Supervision Checklist Supervision Checklist was Supervision Checklist to Value was approved by June approved by June 30 and -- measure quality not 30 and is being piloted in was rolled out in East New implemented Early Adopter Provinces. Britain. Date -- 31-Mar-2022 24-Oct-2023 -- IN01282358 ►PBC 7 Number of PHA Boards that have used routine data for decision making (Text, Output, 1,200,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 No PHA has a Provincial Performance Dashboard; No PHA has a Supportive Supervision Plan. Provincial East New Britain had No PHA has a Provincial Performance Dashboard developed a PHA Performance Dashboard; Framework approved Dashboard and has a Value -- No PHA has a Supportive and under development supportive supervision Supervision Plan with first iteration to be plan approved by the completed by June 30, Project Administrator. 2022. Supportive Supervision Plan expected to be approved by June 30, 2022. Date -- 16-Feb-2023 26-Oct-2023 -- IN01282359 ►PBC 8 Percentage increase in the number of Outreach Clinics in Selected Provinces (Text, Output, 2,100,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 This value is to be Value 0% -36% updated following the -- mission. Date -- 16-Feb-2023 26-Oct-2023 -- IN01282360 ►PBC 9 C-DLI 1: Percentage increase in the number of pregnant women who have received four or more antenatal care check-ups (Text, Intermediate Outcome, 1,200,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 11/1/2023 Page 10 of 13 The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) NDOH has furnished to the Association a report, in form and substance described in the DLI Operational Manual, setting forth the list of Competitive DLI Provinces with a top two (2) highest percentage increase 0%. Increase in ANC 0%. Increase in ANC in the number of Value 0% visits not yet expected. visits not yet expected. pregnant women who have received four (4) or more antenatal care check-ups in Year 5, compared to their respective results in Year 4, as determined in accordance with the details set forth in the DLI Operational Manual. Date -- 23-Jun-2021 26-Oct-2023 -- IN01282361 ►PBC 10 C-DLI 2: Percentage increase in the number of children aged under one (1) year who have received DPT-3 (Text, Intermediate Outcome, 1,200,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 NDOH has furnished to the Association a report, in form and substance described in the DLI Operational Manual, setting forth the list of Competitive DLI Provinces with a top two (2) highest 0%. Increase in 0%. Increase in percentage increase Value 0% immunization rates not immunization rates not yet in the number of yet expected. expected. children under one (1) year of age who have received DPT- 3 in Year 5, compared to their respective results in Year 4, as determined in accordance with the details set forth in the DLI Operational Manual. 11/1/2023 Page 11 of 13 The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) Date -- 23-Jun-2021 26-Oct-2023 -- IN01282362 ►PBC 11 C-DLI 3: Increase in the number of registered DSTB patients on treatment who have been cured (Text, Intermediate Outcome, 1,500,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 NDOH has furnished to the Association a report, in form and substance described in the DLI Operational Manual, setting forth the list of Competitive DLI Provinces with a top two (2) highest increase in the 0% 0%. Increase not yet 0%. Increase not yet Value number of registered expected. expected. drug susceptible tuberculosis patients on treatment who have been cured in Year 5, compared to their respective results in Year 4, as determined in accordance with the details set forth in the DLI Operational Manual. Date -- 23-Jun-2021 26-Oct-2023 -- Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P167184 IDA-64970 Effective USD 30.00 30.00 0.00 1.04 27.56 3.6% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P167184 IDA-64970 Effective 22-Apr-2020 22-Jul-2020 16-Dec-2020 30-Jun-2026 30-Jun-2026 Cumulative Disbursements 11/1/2023 Page 12 of 13 The World Bank Implementation Status & Results Report Improving Access to and Value from Health Services in PNG: Financing the Frontlines (P167184) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 11/1/2023 Page 13 of 13