The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Sint Maarten Hospital Resiliency & Preparedness Project (P167532) LATIN AMERICA AND CARIBBEAN | St Maarten | Health, Nutrition & Population Global Practice | Recipient Executed Activities | Investment Project Financing | FY 2019 | Seq No: 10 | ARCHIVED on 05-Nov-2023 | ISR57826 | Implementing Agencies: Sint Maarten Medical Center (SMMC), Sint Maarten Medical Center (SMMC) Key Dates Key Project Dates Bank Approval Date: 16-Aug-2018 Effectiveness Date: 06-Sep-2018 Planned Mid Term Review Date: 31-Aug-2021 Actual Mid-Term Review Date: 19-Aug-2021 Original Closing Date: 31-Jul-2024 Revised Closing Date: 31-Jul-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) Improve the preparedness and capacity of hospital services in Sint Maarten Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Building and launching of the new hospital:(Cost $24000000.00 M) Transition and Contingency Plan for Sint Maarten Medical Center:(Cost $11085000.00 M) Project Management:(Cost $525000.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Low Low Implementation Status and Key Decisions The Sint Maarten Hospital Resiliency and Preparedness Project was formally launched in October 2018, with the objective of the capacity and preparedness of hospital services in Sint Maarten. This project is not only supporting the financing towards a new hospital building resilient to Category 5 storms, but also improvements to the expansion and quality of hospital services for the population of Sint Maarten. In August 2023, an additional grant in the amount of US$7 million was approved by the Bank to help cover a cost overrun resulting from a substantial increase in the cost of construction activities. The project was also restructured in August 2023 to adjust funds across expenditure categories, modify the results framework, and extend the original grant’s closing date by 10 months to May 31, 2025. Project implementation progress remains satisfactory. Significant progress on the new hospital construction continues with all seven concrete pours for the main building foundation completed and the construction of the ground floor expected by January 2024. The essential upgrades to the existing facility (all completed) have made an important contribution to improving the capacity of hospital services as well as SMMC’s progress towards transitioning to the new building. As a result, the scope of current hospital services has been expanded and overseas referrals have been reduced over the past five years. Activities supported by the project have contributed to repairing structural damages caused by Hurricane Irma; increasing safety, preparedness and overall resilience of the 11/5/2023 Page 1 of 7 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) current hospital; expanding the capacity of select services (e.g., dialysis, chemotherapy, and operating rooms) and providing new services (e.g., ophthalmology, neurology, urology, etc.), among others Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Moderate Moderate Macroeconomic Substantial Moderate Moderate Sector Strategies and Policies Moderate Low Low Technical Design of Project or Program Moderate Low Low Institutional Capacity for Implementation and Substantial Low Low Sustainability Fiduciary Substantial Moderate Moderate Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Low Low Results PDO Indicators by Objectives / Outcomes Improve capacity of hospital services IN01341266 ►Overseas medical referrals reduced (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 91.00 91.00 45.00 Date 31-May-2018 07-Mar-2023 07-Mar-2023 31-Jul-2024 This indicator measures the percent decrease in the number of overseas medical referrals. A referral is defined based on the date SMMC determines they cannot provide treatment at SMMC. Comments: Improve preparedness of hospital services IN01341267 11/5/2023 Page 2 of 7 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) ►Emergency Disaster Preparedness Plan and Evacuation Plan implemented according to procedures (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 83.00 90.00 90.00 Date 31-May-2018 07-Mar-2023 31-Aug-2023 31-Jul-2024 IN01341268 ►Technical audits to evaluate quality and preparedness of service delivery rated satisfactory (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 40.00 90.00 Date 31-May-2018 07-Mar-2023 07-Sep-2023 30-May-2025 Internal technical audits will determine whether clinical guidelines and quality control mechanisms have been implem and the percentage of these cases that are rated Satisfactory. A draft audit tool for technical audits has been prepare Comments: for updating clinical practice guidelines continues. To date, an audit has been conducted of 5 of the 10 targeted CPG considered satisfactory. Intermediate Results Indicators by Components Building and launching of the new hospital IN01341269 ►Progress in construction of new hospital as per category 5 plus specifications (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 20.00 25.00 45.00 Date 31-May-2018 07-Mar-2023 07-Sep-2023 31-Jul-2024 This indicator measures the percentage progress in construction of the new hospital as per Category 5 plus specifications. The end-target was revised downward to 45% as part of the August 2023 restructuring to appropriately reflect that construction was not projected to be completed during the lifetime of the Comments: project. The 45% end-target is derived from the construction timetable. The design phase is also included in the calculation as part of the overall progress in construction. IN01341271 ►Emergency Disaster Preparedness Plan and Evacuation Plan updated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Jun-2018 15-Apr-2022 15-Apr-2022 31-Jul-2024 The EDPP has been updated and a pandemic preparedness chapter has been added. Comments: IN01341273 ►Health personnel trained (Number, Custom) 11/5/2023 Page 3 of 7 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 190.00 287.00 300.00 Date 01-Jun-2018 07-Mar-2023 20-Sep-2023 30-May-2025 SMMC resumed training activities in 2022. Comments: IN01341275 ►Storage capacity to improve preparedness (Square Meter(m2), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 82.00 400.00 400.00 208.00 Date 01-Jun-2018 07-Mar-2023 07-Mar-2023 31-Jul-2024 Greater storage capacity is needed to ensure the provision of services even when extreme weather does not allow for the delivery of supplies. For now, storage capacity has increased by renting additional Comments: storage space off premises. SMMC is planning a permanent structure near the hospital that will increase storage for both sterile and non-sterile items beyond the target. IN01341278 ►Impact of extreme weather conditions on hospital services (admissions, referrals, surgeries) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 60.00 60.00 20.00 Date 31-May-2018 15-Apr-2022 15-Apr-2022 31-Jul-2024 **No category 2 events have occurred during the reporting period to allow for reporting on this indicator.** This indicator measures the percent change of services provided 60 days before and 60 days after an extreme weather event to gauge the impact of the event on the hospital's capacity to remain operational. The specific services tracked will include the number of admissions, surgeries and referrals. "Extreme Comments: weather conditions" include Category 2 hurricanes and higher. In the possible case of multiple, back to back extreme weather events, the indicator would measure 60 days before the first event and 60 days after the last event. Transition and Contingency Plan for Sint Maarten Medical Center IN01341270 ►Progress in essential upgrades to the existing hospital (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 90.00 100.00 100.00 Date 01-Jun-2018 14-Dec-2022 30-Jun-2023 30-May-2025 This indicator measures the percent progress of essential upgrades completed to the existing facility. Comments: IN01341272 ►Contingency Plan in place for continuous services during works and reallocation of services (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/5/2023 Page 4 of 7 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Value No Yes Yes Yes Date 01-Jun-2018 07-Mar-2023 07-Mar-2023 31-Jul-2024 Updated contingency plan (fall back scenario in case of disasters) in place for continuous services during Comments: works and reallocation of services. IN01341274 ►Increased patient satisfaction (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 69.00 73.00 85.00 Date 01-Jun-2018 07-Mar-2023 07-Sep-2023 30-May-2025 SMMC patient satisfaction surveys – already existing mechanism that has been enhanced, including disaggregation of results by gender. Since April 2021, SMMC has been piloting a new approach to the patient satisfaction surveys in order to reach more patients. Quick response (QR) code cards are being Comments: implemented in the Outpatient Department. To date, this new virtual mode of collecting data has increased responses since the onset of the pandemic. IN01341276 Increased patient satisfaction - females (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 72.70 80.20 85.00 Date 02-Jul-2018 24-Jan-2023 20-Sep-2023 30-May-2025 IN01341277 ►Updated clinical guidelines for prevalent health problems implemented and evaluated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.00 5.00 10.00 Date 01-Jun-2018 07-Mar-2023 07-Sep-2023 30-May-2025 This indicator is measured as part of the technical audit and the end-target was revised downward (from 20) as part of the August 2023 project restructuring. The five clinical guidelines conducted to date are Comments: for Status Epilepticus (CG1SE), Cholelithiasis (CG2CH), Hemorrhagic Stroke (CG3HS), Polycystic Ovary Syndrome (CG4PCOS) and Nonsteroidal anti-inflammatory drugs (CG5NSAID). IN01341279 ►Hospital implemented a triage and treatment system including split services between COVID-19 and non-COVID-19 patients (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 16-Mar-2020 15-Apr-2022 15-Apr-2022 31-Jul-2024 IN01341280 ►Number of additional hospital beds to manage and treat COVID-19 suspected and confirmed patients. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/5/2023 Page 5 of 7 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Value 0.00 16.00 16.00 16.00 Date 16-Mar-2020 07-Mar-2023 07-Mar-2023 31-Jul-2024 The Auxiliary Care Facility has a total of sixteen beds, of which six are intensive care beds and 10 are Comments: medium care beds to manage and treat COVID-19 suspected and confirmed cases. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P167532 TF-A8176 Effective USD 25.00 25.00 0.00 22.67 2.33 91% P167532 TF-B3788 Effective USD 3.61 3.61 0.00 3.61 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P167532 TF-A8176 Effective 10-Aug-2018 22-Aug-2018 06-Sep-2018 31-Jul-2023 31-Jul-2024 P167532 TF-B3788 Effective 26-Aug-2020 03-Sep-2020 30-Oct-2020 31-Jul-2024 31-Jul-2024 Cumulative Disbursements 11/5/2023 Page 6 of 7 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Restructuring History Level 2 Approved on 31-Jul-2023 Related Project(s) P174023-Additional Financing for the Sint Maarten Hospital Resiliency & Preparedness Project ,P180854-Second Additional Financing for the Sint Maarten Hospital Resiliency and Preparedness Project 11/5/2023 Page 7 of 7