The World Bank Implementation Status & Results Report Kiribati Health Systems Strengthening Project (P176306) Kiribati Health Systems Strengthening Project (P176306) EAST ASIA AND PACIFIC | Kiribati | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2022 | Seq No: 1 | ARCHIVED on 14-Oct-2022 | ISR52872 | Implementing Agencies: Ministry of Health and Medical Services, Republic of Kiribati Key Dates Key Project Dates Bank Approval Date: 04-Apr-2022 Effectiveness Date: 27-May-2022 Planned Mid Term Review Date: 27-May-2025 Actual Mid-Term Review Date: Original Closing Date: 31-Mar-2027 Revised Closing Date: 31-Mar-2027 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To improve equitable access and quality of health services in targeted areas and in case of an Eligible Crisis or Emergency, respond promptly and effectively to it. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Improving Equitable Access and Quality of Health Services on the Outer Islands:(Cost $4.80 M) Component 2: Strengthening Quality and Range of Services Provided Through Hospitals:(Cost $7.30 M) Component 3: Project Management and Health Information system Enhancement:(Cost $1.90 M) Component 4: Contingent Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO -- Satisfactory Overall Implementation Progress (IP) -- Satisfactory Overall Risk Rating -- Substantial Implementation Status and Key Decisions The project was made effective on May 27, 2022. There has been good progress in finalizing the project’s legal covenants. The key next steps are to initiate project activities, such as a survey of outer island facilities for minor civil works, refurbishment, and procurement of medical equipment under Component 1. 10/14/2022 Page 1 of 7 The World Bank Implementation Status & Results Report Kiribati Health Systems Strengthening Project (P176306) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate -- Moderate Macroeconomic Moderate -- Moderate Sector Strategies and Policies Moderate -- Moderate Technical Design of Project or Program Moderate -- Moderate Institutional Capacity for Implementation and Substantial -- Substantial Sustainability Fiduciary Substantial -- Substantial Environment and Social Substantial -- Substantial Stakeholders Low -- Low Other Moderate -- Moderate Overall Substantial -- Substantial Results PDO Indicators by Objectives / Outcomes Equitable access and quality of health services in the outer islands IN01184459 ►Percentage of outer island facilities offering at least 70 percent of the full range of services as set out in the draft Role Delineation Policy (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 -- 50.00 80.00 Date 31-Dec-2021 -- 06-Sep-2022 31-Mar-2027 Percentage of outer island facilities (clinics/health center) delivering the 17 services as per RDP (Emergency Care, General Outpatient Services, Non-Communicable Diseases, Communicable Diseases, Inpatient Care, Reproductive and Women’s Health, Maternal and Newborn Care, Child and Adolescent Comments: Health, Mental Health, Rehabilitation, Nutrition, Oral Health/Dental, Outreach Services, Pharmacy, Infection Control, Management and Administration, Education, Training and Supervision). Numerator- Number of outer island clinics and health center delivering full range of services. Denominator- Number of all outer island clinics and health center. IN01184460 ►Percentage of women aged 15 to 49 years with a live birth who received antenatal care four times or more (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 70.50 -- 70.50 85.00 10/14/2022 Page 2 of 7 The World Bank Implementation Status & Results Report Kiribati Health Systems Strengthening Project (P176306) Date 31-Dec-2021 -- 06-Sep-2022 31-Mar-2027 Percentage of women aged 15 to 49 years with a live birth who received antenatal care four times or more Comments: Numerator: Number of women who gave birth and received at least four antenatal care visits, measured annually Denominator: Number of women who gave birth in that year. IN01184521 Outer Islands (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value TBD -- TBD TBD IN01184522 South Tarawa (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value TBD -- TBD TBD Quality and range of health services in hospitals IN01184458 ►Reduction of rate of Methicillin Resistant Staphylococcus Aureus (MRSA, Multi-Resistant Organisms) across the two main hospitals (Tungaru Central Hospital and London Kiritimati Hospital) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.80 -- 32.80 20.00 Date 31-Dec-2020 -- 06-Sep-2022 31-Mar-2027 Comments: Proportion of MRSA detected from all positive staphs aureus cultures in all specimens. Intermediate Results Indicators by Components Component 1: Improving Equitable Access and Quality of Health Services on the Outer Islands IN01184524 ►Number of outer island health centers/clinics that meet minimum standards for equipment, essential medicines, and staffing number per the RDP (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value TBD -- TBD 70.00 Date 31-Dec-2021 -- 06-Sep-2022 31-Mar-2027 Definition: The number of outer island health centers and clinics that have the agreed medicines/equipment/staff per the RDP. Note: The baseline will be determined at the start of project Comments: implementation. Due to the COVID-19 shutdowns and travel restrictions, it was not possible to carry out a baseline survey/assessment. MHMS will conduct the survey/assessment during implementation and the baseline will be updated then. IN01184527 ►Number of outer island clinics connected to the main hospital (tele-health) (NHSP CI-26) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 10/14/2022 Page 3 of 7 The World Bank Implementation Status & Results Report Kiribati Health Systems Strengthening Project (P176306) Value 0.00 -- 0.00 22.00 Date 31-Dec-2021 -- 06-Sep-2022 31-Mar-2027 Comments: Number of health centers and clinics in outer islands connected to main hospital through telehealth. IN01184529 ►Number of integrated outreach programs conducted in the outer islands (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 8.00 Date 31-Dec-2021 -- 06-Sep-2022 31-Mar-2027 Total number of visits to the outer islands regardless of number of islands reached. Integrated medical outreach programs incudes a team that consist of doctors, nurse, lab technician, pharmacist, Comments: radiographer, biomed, programs. The number of islands visited will be collected at the completion of each visit. IN01184531 ►Percentage of health care workers, disaggregated by urban and outer islands and by sex, with the knowledge to recognize, medically manage, and refer GBV survivors to appropriate services (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target TBD Value TBD -- 70.00 Date 31-Dec-2021 -- 06-Sep-2022 31-Mar-2027 Definition: Cumulative percentage of health care workers trained and assessed as competent to identify GBV risks, medically manage cases and refer GBV survivors. A GBV module will be integrated to all in- service training supported through the project - .to include topics such as identifying GBV risks, medically Comments: manage cases, and refer GBV survivors among others. Note: The baseline data (32 percent) provided during appraisal requires further discussion and confirmation to ensure it takes into account competency. The baseline will be determined at the start of project implementation following further investigation of MHMS reported data and/or conducting a focus group discussion or a rapid assessment on competency. IN01184533 Percentage of women (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value TBD -- TBD TBD IN01184534 Percentage from outer islands (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value TBD -- TBD TBD Component 2: Strengthening Quality and Range of Services Provided Through Hospitals IN01184523 ►Percent of core clinical health services, as set out in the RDP, offered in Kiritimati hospital (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 -- 60.00 85.00 10/14/2022 Page 4 of 7 The World Bank Implementation Status & Results Report Kiribati Health Systems Strengthening Project (P176306) Date 31-Dec-2021 -- 06-Sep-2022 31-Mar-2027 The RDP lists 50 clinical services that are grouped into General surgery, Obstetrics and Gynecology, Comments: Anesthesia, Internal medicine, pediatrics plus dental health. IN01184526 ►Number of staff (re) trained and (re) assessed as competent in infection prevention and control and waste management as per MHMS protocols (IPC guideline) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 -- 60.00 280.00 Date 31-Dec-2021 -- 06-Sep-2022 31-Mar-2027 IPC training includes; chain of infection, hand hygiene and standard precautions, isolation of patients and PPEs, Aseptic non-touch techniques, surveillance, waste management such as types and disposal of Comments: waste (that encompasses all healthcare workers (MA, Midwives, PHN, Doctors (District/referrals) nationwide. (406 staff) new recruits averaged around 24 yearly. Component 3: Project management and health information system enhancement IN01184525 ►Number of core health indicator dashboard updates for health program managers (linked to 6.4.3 NHSP) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 16.00 Date 31-Dec-2021 -- 06-Sep-2022 31-Mar-2027 Number of times core health indicators identified in the NHSP to monitor implementation are included in Comments: the Tupaia platform and made available for management. IN01184528 ►Number of Health Sector Coordination Committee (HSCC) meetings held to reflect on progress using core health indicator dashboard and priority next steps (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 1.00 8.00 Date 31-Dec-2021 -- 06-Sep-2022 31-Mar-2027 Comments: HSCC convened by MHMS with MFED and partners (targeting at least every six months). IN01184530 ►Number of health facilities exceeding a 75 percent score on the satisfaction survey (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 20.00 Date 31-Dec-2021 -- 06-Sep-2022 31-Dec-2027 "Health facilities” captures the total number of hospitals (4) and targeted health centers (37) in South Tarawa and outer islands (total n=41). The indicator target is twenty health facilities exceeding a 75 Comments: percent score on the satisfaction survey. The survey will target visitors, patients, and health system workers. IN01184532 ►Share of grievances recorded through the GRM that are resolved within agreed timeframes (Percentage, Custom) 10/14/2022 Page 5 of 7 The World Bank Implementation Status & Results Report Kiribati Health Systems Strengthening Project (P176306) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 80.00 Date 31-Mar-2022 -- 06-Sep-2022 31-Mar-2026 Comments: Agreed timeframe to be stipulated in the Project Operations Manual. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P176306 IDA-D9880 Effective USD 14.00 14.00 0.00 0.33 12.51 2.6% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P176306 IDA-D9880 Effective 04-Apr-2022 24-Apr-2022 27-May-2022 31-Mar-2027 31-Mar-2027 Cumulative Disbursements 10/14/2022 Page 6 of 7 The World Bank Implementation Status & Results Report Kiribati Health Systems Strengthening Project (P176306) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 10/14/2022 Page 7 of 7