The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Sri Lanka: Primary Health Care System Strengthening Project (P163721) SOUTH ASIA | Sri Lanka | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2018 | Seq No: 12 | ARCHIVED on 01-Dec-2023 | ISR58645 | Implementing Agencies: Democratic Socialist Republic of Sri Lanka, Ministry of Health, Nutrition and Indigenous Medicine Key Dates Key Project Dates Bank Approval Date: 27-Jun-2018 Effectiveness Date: 23-Jan-2019 Planned Mid Term Review Date: 10-Jan-2022 Actual Mid-Term Review Date: 17-Jan-2022 Original Closing Date: 31-Dec-2023 Revised Closing Date: 31-Dec-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is to increase the utilization and quality of primary health care services, with an emphasis on detection and management of non-communicable diseases in high-risk population groups, in selected areas of the country. 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 project development objective is to increase the utilization and quality of primary health care services, with an emphasis on detection and management of non-communicable diseases in high-risk population groups, in selected areas of the country and to provide immediate and effective response to an Eligible Crisis or Health Emergency. Components Table Name Implementation of the PHC System Reorganization and Strengthening Strategies:(Cost $4404.00 M) Project Implementation Support and Innovation Grants:(Cost $5.22 M) Contingent Emergency Response Component:(Cost $9.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions Overview: Targets for two out of four Project Development Objective (PDO) indicators have been achieved and remaining two are pending verification. Additionally, 23 out of 30 intermediate results (IR) indicators have been achieved. The project has disbursed US$137.07 million till date (68.5% of total IBRD lending) (US$125.1 million under Component 1; US$3.6 million under Component 2; and US$8.9 million under CERC). A total of US$62.93 million remains undisbursed, of which US$59.9 million is for Component 1 and 3.0 million for 12/1/2023 Page 1 of 10 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Component 2. Around US$47 million is expected to be disbursed following the completion of the ongoing verification. The Mission, therefore, has retained the PDO rating as "Moderately Satisfactory" and the Implementation Progress as "Satisfactory". The Government of Sri Lanka (GoSL) is planning to request a 6-month no-cost extension to satisfactorily complete the activities and achieve the pending PDO and other result indicators (proposed revised closing date is June 30, 2024). Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Moderate Moderate Macroeconomic Moderate Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and Moderate Moderate Moderate Sustainability Fiduciary Moderate Moderate Moderate Environment and Social Low Moderate Moderate Stakeholders Substantial Moderate Moderate Other -- -- -- Overall Substantial Moderate Moderate Results PDO Indicators by Objectives / Outcomes Increase utilization of PHC services, particularly prevention/management of NCDs in high-risk groups IN01364175 ►Number of women at age 35 and at age 45 years who are screened for cervical cancer at a network of public health facilities (DLI 8) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 107,551.00 160,000.00 238,000.00 213,000.00 Date 31-Dec-2017 30-May-2023 31-Oct-2023 31-Dec-2023 IN01364253 ►Percentage of screened adults with high risk for non-communicable diseases who are registered and actively followed-up at primary medical care institutions (DLI 9) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/1/2023 Page 2 of 10 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Value 0.00 72.00 68.00 25.00 Date 29-Dec-2017 30-May-2023 31-Oct-2023 31-Dec-2023 Data on this indicator were manually reported since the IT-enabled HMIS at PMCIs with networking for extended clin risk patient follow-up is not yet available. The target of 25 percent has been achieved using manual registries for the June 2021 (year 3). Comments: IN01364254 Male (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.00 15.00 25.00 Date 31-Dec-2017 30-May-2023 31-Oct-2023 31-Dec-2023 IN01364255 Female (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.00 15.00 25.00 Date 31-Dec-2017 30-May-2023 31-Oct-2023 31-Dec-2023 Increase in the quality of PHC services, in selected areas of the country IN01364251 ►The number of primary medical care institutions that have the required capabilities for providing comprehensive and quality care. (DLI 3) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 377.00 550.00 550.00 Date 31-Dec-2017 30-May-2023 31-Oct-2023 31-Dec-2023 Pending verification. Comments: 458 PMCIs have reported to have additional capabilities. To provide immediate and effective response to an Eligible Crisis or Health Emergency IN01364252 ►CERC implemented according to the Emergency Action Plan (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Dec-2020 30-May-2023 30-May-2023 31-Dec-2023 Comments: DLI met 12/1/2023 Page 3 of 10 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Intermediate Results Indicators by Components Implementation of the PHC System Reorganization and Strengthening Strategies IN01364258 ►MoH and Provinces endorse policies and standards for reorganizing PHC (DLI 1) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target MoH and Provinces Policies and standards endorse the package sufficient to guide PHC of circulars and Value Completed Completed Reorganization do not guidelines necessary exist for PHC model implementation Date 03-Sep-2018 30-May-2023 30-May-2023 30-Jun-2019 The end target for this result has been achieved. Comments: IN01364261 ►MoH adopts and updates clinical protocols for selected health conditions (DLI 2) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target No clinical protocols Package of protocols Package of protocols Package of protocols targeted for the PHC adopted for defined adopted for defined adopted for defined Value level exist for the defined selected health selected health selected health tracer conditions conditions. conditions. conditions Date 03-Sep-2018 30-May-2023 30-May-2023 30-Jun-2019 The end target for this result has been achieved. Comments: IN01364263 ►Number of annual progress reviews on MoH Action Plan, including Project Results Indicators at the central MoH (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 4.00 3.00 Date 03-Sep-2018 30-May-2023 30-May-2023 31-Dec-2023 Target achieved. Comments: IN01364264 ►Number of patient-friendly services provided on the basis of 4 types of services at the PMCIs (DLI 4) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 871.00 871.00 550.00 Date 03-Sep-2018 30-May-2023 31-Oct-2023 31-Dec-2023 12/1/2023 Page 4 of 10 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Target achieved in 2020, verification is in progress for its continuity. Comments: IN01364265 ►Percentage of Medical Officers (both Medical Officers of Health in the Public Health stream and Medical Officers at PMCIs) trained on essential service package on NCDs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 56.00 60.00 70.00 Date 01-Jul-2018 30-May-2023 31-Oct-2023 31-Dec-2023 IN01364266 ►Percentage of PMCIs with transport facilities for dispatching the samples for investigations to apex laboratories (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 57.00 57.00 55.00 Date 03-Sep-2018 30-May-2023 30-May-2023 31-Dec-2023 The indicator has met the target. Comments: IN01364267 ►Percentage of PMCIs with capability for primary detection and management of dengue (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 58.00 58.00 55.00 Date 31-Dec-2017 30-May-2023 30-May-2023 31-Dec-2023 The target for this indicator has been met. Comments: IN01364268 ►Percentage of PMCIs providing a standard primary oral health care package (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 60.00 60.00 55.00 Date 03-Sep-2018 30-May-2023 30-May-2023 31-Dec-2023 This is available in 460 of the 1010 PMCIs in Sri Lanka. The end target for this indicator has been met. Comments: IN01364269 ►Percentages of PMCIs with basic emergency care facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 69.00 69.00 50.00 Date 03-Sep-2018 30-May-2023 30-May-2023 31-Dec-2023 Comments: The end target for this indicator has been achieved. 12/1/2023 Page 5 of 10 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) IN01364270 ►Percentage of Medical Officer of Health areas offering mental health services in at least one PMCI (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 75.00 75.00 35.00 Date 03-Sep-2018 30-May-2023 30-May-2023 31-Dec-2023 The end target for this indicator has been achieved. Comments: IN01364271 ►Percentage of PMCIs with capability for TB screening and referral (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 53.00 53.00 45.00 Date 03-Sep-2018 30-May-2023 30-May-2023 31-Dec-2023 The end target for this indicator has been achieved. Comments: IN01364272 ►Percentage of public sector schools implementing health promoting programs (health promoting schools) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 31.00 33.00 33.00 35.00 Date 31-Dec-2017 30-May-2023 30-May-2023 31-Dec-2023 The end target for this indicator has been achieved. Comments: IN01364273 ►Number of PMCIs that use personal health records to coordinate patient care over time and through the referral chain (DLI 5) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 438.00 550.00 550.00 Date 03-Sep-2018 30-May-2023 31-Oct-2023 31-Dec-2023 Pending verification Comments: IN01364274 ►Number of PMCIs connected to and using the Medical Supplies Management Information System (DLR 6.1) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 62.00 202.00 550.00 Date 03-Sep-2018 30-May-2023 31-Oct-2023 31-Dec-2023 Pending verification. Comments: 12/1/2023 Page 6 of 10 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) IN01364275 ►Percentage of annual procurement by MSD that is less than or equal to defined performance benchmarks (DLR 6.3) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 90.00 90.00 70.00 Date 31-Dec-2016 30-May-2023 30-May-2023 31-Dec-2023 IN01364276 ►The use of the urgent procurement procedure as a percent of total medical supplies procurement that is reduced from the established baseline (DLR 6.5) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 40.00 Date 31-Dec-2017 30-May-2023 30-May-2023 31-Dec-2023 IN01364277 ►Community Engagement Mechanism for health sector operational, including grievance redressal mechanism (DLI 7) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target MoH makes public There is no operational consolidated annual community engagement Value Completed Completed report for the health and grievance redressal sector grievance mechanism redressal mechanism Date 03-Sep-2018 30-May-2023 30-May-2023 31-Dec-2022 IN01364278 ►Number of PMCIs with active community engagement committees (DLR 7.5) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 414.00 410.00 550.00 Date 03-Sep-2018 30-May-2023 31-Oct-2023 31-Dec-2023 Pending verification Comments: IN01364279 ►Adequate and timely release of treasury funds requested to health sector program (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 75.00 75.00 75.00 85.00 Date 31-Dec-2017 30-May-2023 31-Oct-2023 31-Dec-2023 IN01364280 ►Percentage of Medical Officer of Health areas offering minimum COVID-19/emergency outbreak, epidemic management responses at OPD or and Emergency Department (ETU) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 30.00 32.00 35.00 12/1/2023 Page 7 of 10 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Date 30-Jan-2020 30-May-2023 31-Oct-2023 31-Dec-2023 In progress Comments: Project Implementation Support and Innovation Grants IN01364256 ►Percentage of MoH and district training/capacity building plans developed and monitored (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 35.00 35.00 40.00 Date 03-Sep-2018 30-May-2023 31-Oct-2023 31-Dec-2023 This indicator was revised: Percentage of training program completed over planned activities. Comments: IN01364259 ►Number of innovative subprojects supported, evaluated and disseminated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8.00 8.00 11.00 Date 03-Sep-2018 30-May-2023 31-Oct-2023 31-Dec-2023 Comments: Contingent Emergency Response Component IN01364257 ►Tele-education broadcasts available in all nine provinces (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Dec-2020 30-Dec-2022 30-Dec-2022 30-Dec-2022 IN01364260 ►Number of direct project beneficiaries reached with seeds, planting material, compensation, equipment, works and services for COVID-19 recovery, segregated by gender (Number (Thousand), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 265.00 265.00 100.00 Date 30-Dec-2020 31-Dec-2021 31-Dec-2021 30-Dec-2022 IN01364262 ►Number of institutions benefiting from improved digital tools for secure and resilient continuity of operations (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 12/1/2023 Page 8 of 10 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Date 01-Dec-2020 30-May-2023 30-May-2023 31-Dec-2023 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P163721 IBRD-88780 Effective USD 200.00 200.00 0.00 137.07 62.93 69% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P163721 IBRD-88780 Effective 27-Jun-2018 23-Jan-2019 23-Jan-2019 31-Dec-2023 31-Dec-2023 Cumulative Disbursements 12/1/2023 Page 9 of 10 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Restructuring History Level 2 Approved on 05-Jan-2021 ,Level 2 Approved on 11-May-2022 Related Project(s) There are no related projects. 12/1/2023 Page 10 of 10