The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Transforming Egypt's Healthcare System Project (P167000) MIDDLE EAST AND NORTH AFRICA | Egypt, Arab Republic of | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2018 | Seq No: 7 | ARCHIVED on 20-Jan-2022 | ISR48863 | Implementing Agencies: Ministry of Investment and International Cooperation, Ministry of Health and Population Key Dates Key Project Dates Bank Approval Date: 27-Jun-2018 Effectiveness Date: 07-Sep-2018 Planned Mid Term Review Date: 14-Jan-2021 Actual Mid-Term Review Date: 15-Apr-2021 Original Closing Date: 31-Dec-2023 Revised Closing Date: 31-Dec-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed Project Development Objective is to (i) improve the quality of primary and secondary health care services, (ii) enhance demand for health and family planning services, and (iii) support the prevention and control of Hepatitis C. 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 proposed Project Development Objective is to (i) improve the quality of primary and secondary health care services, (ii) enhance demand for health and family planning services, (iii) support the prevention and control of Hepatitis C, and (iv) to provide immediate and effective response to an eligible crisis or emergency. Components Table Name Component 1: Strengthen Primary Healthcare, Family Planning and Community Activities:(Cost $237.41 M) Component 2: Strengthen Secondary Level Healthcare:(Cost $276.60 M) Component 3: Institutional Capacity Building and Project Management:(Cost $8.00 M) Component 5: Contingency Emergency Response Component 4: Contingency Emergency Response-Early COVID-19 Response:(Cost $7.99 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions The project was approved by the World Bank Board of Executive Directors on June 27, 2018 and was declared effective on September 7, 2018. The project has been progressing steadily towards achieving the PDO. The project is on track to achieve its PDO given the progress achieved since 2/24/2022 Page 1 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) effectiveness in September 2018. A functioning Project Management Unit (PMU) is in place, and disbursement rate is at 57.96 percent. Disbursements are expected to accelerate considerably after the effectiveness of the ongoing restructuring which will pave the way for further disbursements under the Plasma safety and sufficiency program, as well as the inclusion of the Unified Procurement Agency (UPA) as a procurement agency for the project. The later will facilitate nearly US$ 80 million worth of procurement activities for medical activities. Component 1 remains rated at “Satisfactory” as the screening of Hep C and Non-Communicable Diseases (NCDs) has exceeded its targets and has been completed two years earlier than planned. Further, significant progress has been made on the quality improvement of primary healthcare facilities and the Community Health Workers (CHWs). Component 2 remains rated as “Moderately Satisfactory” (MS) owing to the mixed results with regards overachieving the targets for Hep C treatment and delays in supplying the needed medical equipment for hospitals. Component 3 will remain rated as Moderately Satisfactory with significant ongoing support to the institutional capacity building of the General Authority for Healthcare (GAHC), and Component 4 (CERC) remains rated Satisfactory. Procurement and FM ratings remains as Moderately Satisfactory. 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 Substantial Substantial Substantial Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and Moderate Moderate Moderate Sustainability Fiduciary High Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Substantial Substantial Substantial Other -- Low Low Overall Substantial Moderate Moderate Results PDO Indicators by Objectives / Outcomes Improve the quality of primary health care services IN01093908 ►Number of PHCs passing Quality Services Index composite indicators list (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 217.00 600.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 2/24/2022 Page 2 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) The QSI manual and action plan for targeted PHCs staff training is completed and 130 PHCs are being Comments: monitored for phase one to be verified by the end of 2020. IN01093946 ►Percentage improvement in the average quality of clinical care score at all targeted PHCs, measured through independent direct observations (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 54.96 68.50 80.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 The average total quality score percent in all 8 Governorates is 54.96%. The highest score was in Comments: Elbeheira with 78.2% and the lowest was in South Sinai with 41.0%. The year 2 target has been met. Improve the quality of secondary health care services IN01093941 ►Percentage improvement in the average quality of clinical care score at all targeted hospitals measured through independent direct observations (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 66.00 93.00 80.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 The WHO report for year 3 targets is due by December 2021. The % from the previous report has been kept. The total average quality of clinical care score in the four hospitals is 66%, with the highest score Comments: in the Aswan Specialized hospital with 78.24% and the lowest in the Alagamy Central hospital with 57.5%. IN01093948 ►Percentage of blood units dispensed at MOHP affiliated hospitals that have been screened utilizing the Nucleic Acid test (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 90.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 Procurement activities have been on hold since procurement is assigned to the Unified Procurement Agency (UPA). MOHP has formally requested a restructuring of the activity to finance the acquisition of Comments: COVID vaccines and will be reflected in the 2nd project restructuring. Enhance Demand for Health and Family Planning Services IN01093910 ►Contraceptive prevalence rate (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 58.00 58.00 58.00 65.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 2/24/2022 Page 3 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Data for this indicator is not required until year 3. Comments: Prevention and control of Hepatitis C IN01093909 ►Number of people screened for Viral Hepatitis C (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 49,931,654.00 49,931,654.00 35,000,000.00 Date 02-Jul-2018 15-Aug-2019 31-Dec-2021 31-Dec-2023 The end target for the screen of Hepatitis C has been met (and exceeded) 3 years earlier than planned. Comments: IN01093978 Percent Female (Percentage, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 52.00 52.00 50.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 29-Dec-2023 IN01093951 ►Percentage of people who received treatment for Hepatitis C who have taken the final confirmation test for sustained virological response (SVR) using a random sampling methodology (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 79.00 72.80 80.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 While the end target was met at June 2019’s ISR reaching 89%, the actual is now lower than before at 72.8% (actual) and slightly exceeds the target. While the achieved percentage exceeds the target for project implementation at this point which is 70%. The Ministry of Health and Population is actively Comments: working to ensure that patients who tested positive for Hep C receive the full treatment and final confirmatory test. And due to the covid-19 epidemic and immense need of new medications and delays in the procurement process, the testing program has been on hold and hence the change in the data. Contingency Emergency and Response IN01093943 ►Number of clinical screenings of suspected COVID-19 cases by a trained physician/nurse at port of entries, quarantine facilities, community and/or healthcare facilities (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 200,000.00 Date 28-Jan-2021 -- 31-Dec-2021 31-Dec-2023 Data for this indicator will be updated in the next ISR when IVA verification is completed. Comments: Overall Comments PDO 2/24/2022 Page 4 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Data for the newly added inidicators and PBCs under the restructuring which was approved in Janauary 2022, will be upated once verification is completed. Intermediate Results Indicators by Components Strenghten Primary Healthcare, Family Planning and Community Activities IN01093942 ►PHC mapping exercise, needs assessments and new accreditation tool completed. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 3.00 4.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 The PHC needs assessments and the mapping exercises have been completed and the accrediatation Comments: tool has been published. IN01093949 ►Increased household visits by CHWs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7.00 7.00 21.70 32.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 This indicator is measured yearly. Activities related to CHW are difficult to calculate, in light of Covid-19 as the visits can no longer be conducted at the household level but are taking place in markets, transportation stations and common public areas. While CHW visits are still documented, there is difficulty Comments: in documenting individual details at the household level. Target for year 3 has been dropped under the project restructuring. IN01093952 ►Percentage of participating districts certified for enhanced governance performance (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 21.30 36.00 100.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 The curriculum for financial training (65 districts) has been completed, as the action plan for the training. 21.3 percent of participating districts are certified for enhanced governance performance. As for the second year, the training and verification have been done. the result surpassed the required minimum Comments: percentage for the second year of the project of 40 %, by reaching 58.3%.The curriculum for financial training (65 districts) has been completed, as has the action plan for the training. Year 2 training is on- going, to be assessed by the end of the year. IN01093955 ►Client user satisfaction and utilization surveys conducted in project target areas (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 2/24/2022 Page 5 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Value 0.00 1.00 2.00 5.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 This indicator is measured yearly. Comments: IN01093956 ►Grievances addressed in project target facilities using the GRM in accordance with the revised manual issued in 2017 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 20.00 80.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 This indicator is measured yearly and its target start at the end of the second year. The GRM manual has been completed and printed and training on the GRM delivered. The GRM manual has been distributed to Comments: all the governorates. This indicator is currently being verified by the IVA. IN01093959 ►Average patient satisfaction level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 66.50 69.00 65.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 A pilot study for the patient satisfaction tool was conducted. The average total patient satisfaction percent score in all pilot PHCs was 69%. The highest average total of patients’ satisfaction percent score in all included PHCs in the 5 governorates was for ELbeheira with 79% and the lowest was for Matrouh with Comments: 51%. The lowest components were generally of continuity of care and comprehensiveness of services. Next IVA report is expected by December 2021. IN01093962 ►Targeted people screened for NCDs (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 49,931,654.00 49,931,654.00 20,000,000.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 The end target has been met (and exceeded) 3 years ahead of schedule. Comments: IN01093980 Percent Female (Percentage, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 52.00 52.00 50.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 29-Dec-2023 IN01093965 ►Targeted PHCs applying environmentally-positive energy and water efficiency measures (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 2/24/2022 Page 6 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Value 0.00 0.00 271.00 600.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 Needs assessment for energy saving lamps has been done for 113 PHCs for phase one and the monitoring for second patch was done for around 158 units and the monitoring for the third patch is Comments: underway for 109 units. IN01093966 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,350,411.00 1,788,360.00 3,400,000.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 IN01093981 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,350,911.00 1,788,360.00 3,400,000.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 Strengthen Secondary Level Healthcare IN01093944 ►Targeted regional blood banks that have been connected to the national automated blood network. (Amount(USD), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 11.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 IN01093950 ►Targeted Hep C patients treated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,056,274.00 1,385,453.00 1,500,000.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 The year 4 target has been met, 3 years early. Comments: IN01093979 Percent Female (Percentage, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 56.00 43.00 40.00 Date 20-Jun-2018 02-Mar-2020 31-Dec-2021 29-Dec-2023 IN01093954 2/24/2022 Page 7 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) ►Number of PHCs receiving National Accreditation Certification for healthcare quality (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 113.00 600.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 The target will be dropped under the 2nd project restructuring. The related support will be restructured to Comments: support of the 100 million healthy lives campaign. IN01093957 ►Number of Hospitals receiving National Accreditation Certification for healthcare quality in target governorates (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 27.00 Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 The tool for accreditation has been published for both hospitals and primary centers. It is currently being Comments: verified by IVA. IN01093958 ►Number of plasma centers passing the PQI composite indicator. (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 10.00 Date 28-Jan-2021 -- 31-Dec-2021 31-Dec-2023 IN01093961 ►Number of plasma units that were properly collected, transferred, tested and stored. (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 250,000.00 Date 28-Jan-2021 -- 31-Dec-2021 31-Dec-2023 IN01093963 ►Number of conducted rounds of the national online licensing/specialization examinations. (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 2.00 Date 28-Jan-2021 -- 31-Dec-2021 31-Dec-2023 Institutional Capacity Building ad Project Management IN01093945 ►Project results published regularly on external MOHP website (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 2/24/2022 Page 8 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Value 0.00 Yes Yes Yes Date 02-Jul-2018 02-Mar-2020 31-Dec-2021 31-Dec-2023 End target achieved. Comments: Performance-Based Conditions IN01093947 ►PBC 1 Development of quality tools and mechanisms (Text, Intermediate Outcome, 4,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 PBCS 1.1, 1.2,1.3 Accreditation guidelines Value -- accomplished. PBC1.4 -- developed. pending verification Date -- -- 31-Dec-2021 -- IN01093953 ►PBC 2 Grievances addressed in project target facilities using the GRM in accordance with the revised manual issued in 2017 (Percentage, Intermediate Outcome, 7,500,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 -- 40.00 80.00 Date -- -- 31-Dec-2021 -- IN01093960 ►PBC 3 Percentage of participating districts certified for enhanced governance performance (Percentage, Intermediate Outcome, 2,500,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 -- 40.00 100.00 Date -- -- 31-Dec-2021 -- IN01093964 ►PBC 4 Number of PHCs passing Quality Services Index composite indicators list (Number, Outcome, 60,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 2/24/2022 Page 9 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Value 0.00 -- 271.00 -- Date -- -- 31-Dec-2021 -- IN01093967 ►PBC 5 Increased household visits by CHWs (Percentage, Intermediate Outcome, 2,400,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Value 7.00 -- 17.00 32.00 Date -- -- 31-Dec-2021 -- IN01093968 ►PBC 6 Contraceptive prevalence rate (Percentage, Output, 3,200,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Value 58.00 -- 58.00 65.00 Date -- -- 31-Dec-2021 -- IN01093969 ►PBC 7 Targeted people screened for NCDs (Number, Outcome, 4,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 -- 52,000,000.00 -- Date -- -- 31-Dec-2021 -- IN01093970 ►PBC 8 Number of people screened for Viral Hepatitis C (Number, Outcome, 129,600,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 -- 52,000,000.00 -- Date -- -- 31-Dec-2021 -- 2/24/2022 Page 10 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) IN01093971 ►PBC 9 Percentage of people who received treatment for Hepatitis C who have taken the final confirmation test for sustained virological response (SVR) using a random sampling methodology (Percentage, Outcome, 2,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 -- 70.00 70.00 Date -- -- 31-Dec-2021 -- IN01093972 ►PBC 10 Number of conducted rounds of the national online licensing/specialization examinations. (Number, Output, 2,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 -- 0.00 -- Date -- -- 31-Dec-2021 -- IN01093973 ►PBC 11 Development of Plasma Quality Tools (Text, Output, 10,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Plasma Quality Tools Plasma Quality Tools Value -- 0.00 developed developed Date -- -- 31-Dec-2021 -- IN01093974 ►PBC 12 Number of plasma centers passing the PQI composite indicator. (Number, Output, 9,200,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 -- 0.00 -- Date -- -- 31-Dec-2021 -- IN01093975 ►PBC 13 Number of plasma centers receiving Good Manufacturing Practices (GMP) certificates (Number, Output, 7,560,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 2/24/2022 Page 11 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Value 0.00 -- 0.00 12.00 Date -- -- 31-Dec-2021 -- IN01093976 ►PBC 14 Number of plasma units that were properly collected, transferred, tested and stored. (Number, Output, 3,440,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 -- 0.00 -- Date -- -- 31-Dec-2021 -- IN01093977 ►PBC 15 Number of clinical screenings of suspected COVID-19 cases by a trained physician/nurse at port of entries, quarantine facilities, community and/or healthcare facilities (Number, Output, 7,909,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 -- 0.00 -- Date -- -- 31-Dec-2021 -- Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P167000 IBRD-88950 Effective USD 530.00 530.00 0.00 307.19 222.81 58% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P167000 IBRD-88950 Effective 27-Jun-2018 10-Jul-2018 07-Sep-2018 31-Dec-2023 31-Dec-2023 Cumulative Disbursements 2/24/2022 Page 12 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History Level 2 Approved on 20-Jul-2021 Related Project(s) There are no related projects. 2/24/2022 Page 13 of 13