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: 8 | ARCHIVED on 25-Sep-2022 | ISR51166 | Implementing Agencies: Ministry of Health and Population, Ministry of Investment and International Cooperation 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 Project status. The Ministry of International Cooperation (MOIC) has requested a 2-year extension to the project closing date to ensure achieving the Project Development Objectives (PDO). The World Bank team and the Project Management Unit (PMU) at the Ministry of Health and Population 9/25/2022 Page 1 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) (MOHP) are jointly reviewing the request. The overall PDO is rated as Moderately Satisfactory based on progress to date and available data. 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” due to the mixed results regarding 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). Component 4 (Early COVID-19 Response) remains rated Satisfactory. Procurement rating improved to Satisfactory as procurement documents are being uploaded to STEP in a timelier manner. Financial Management continues to be rated Moderately Satisfactory as the establishment of an Internal Audit function and adopting the new MIS needs further improvement. 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 IN01132585 ►Number of PHCs passing Quality Services Index composite indicators list (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 217.00 376.00 600.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 QSI manual and action plan for the targeted PHC’s staff training are completed. Three batches of PHCs Comments: verification has been completed for 113, 158 and 105 PHCs respectively. 9/25/2022 Page 2 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) IN01132640 ►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 68.50 65.90 80.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 Out of the 7 governorates, Elbehira recorded the highest average total quality score (89.5%) and the lowest was for Matrouh (34.4%). The current percentage surpasses the targets for year 3 and is on track Comments: to be achieved for year 4. Improve the quality of secondary health care services IN01132638 ►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 93.00 80.95 80.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 Aboqeir specialized hospital recorded the highest precentage improvement in the average quality of clinical care score (95.8%) and the lowest was Beni Suef specialized hospital (49.8%). The achieved Comments: percentage surpasses the target of year 3 (and end target). IN01132641 ►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 31-Dec-2021 15-May-2022 31-Dec-2023 Procurement activities have been on hold since procurement is assigned to the Unified Procurement Agency (UPA). MOHP and UPA are currently finalizing a Memorundum of Understanding (MoU) which will Comments: guide their relationship moving forward. Enhance Demand for Health and Family Planning Services IN01132637 ►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 31-Dec-2021 15-May-2022 31-Dec-2023 9/25/2022 Page 3 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Prevention and control of Hepatitis C IN01132636 ►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 31-Dec-2021 15-May-2022 31-Dec-2023 The end target for the screen of Hepatitis C has been met (and surpassed) 3 years earlier than planned. Comments: IN01132642 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 31-Dec-2021 15-May-2022 29-Dec-2023 IN01132643 ►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 72.80 72.80 80.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 Despite this indicator surpassing the end target in June 2019’s ISR (89%) it has since receeded (72.8%). Nonetheless, it could be on track to achieve year 3/4 intermediate target (75%). MOHP continues to actively ensure that patients who tested positive for Hep C receive the full treatment and final confirmatory Comments: test. However, the COVID-19 pandemic coupled with the delay of the procurement process (causing a shortage in medication), the treatment has been on hold and no change in the data. Contingency Emergency and Response IN01132639 ►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 0.00 200,000.00 200,000.00 Date 28-Jan-2021 31-Dec-2021 15-May-2022 31-Dec-2023 Intermediate Results Indicators by Components Strenghten Primary Healthcare, Family Planning and Community Activities IN01132644 ►PHC mapping exercise, needs assessments and new accreditation tool completed. (Number, Custom) 9/25/2022 Page 4 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3.00 4.00 4.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 PHCs needs assessments and mapping exercise are completed. The last tool, which is the second needs assessment is completed from MOHP side, is submitted for verification which expected to be comleted by Comments: the end of 2022 IN01132647 ►Increased household visits by CHWs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7.00 21.70 17.80 32.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 This indicator is measured yearly. Activities related to CHWs have become difficulet to measure following the COVID-19 pandemic as the household visits were postponed and were replaced with public meetings in open areas such as markets, transportation stations and common public areas. While CHW visits are Comments: still documented, there is difficulty in documenting individual details at the household level. As result ofthe difficulty in tracking this, the target for year 3 was officially dropped. The target for year 4 will be verified by the end of 2022 IN01132649 ►Percentage of participating districts certified for enhanced governance performance (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 36.00 73.60 100.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 The districts that fall in the scope of the project's target governorates were certified for training for 2 management level positions and 3 fiduciary level positions from that same district, thus achieving the Comments: fiduciary training successfully (73%) and surpassed the required minimum percentage for the third year (60%) IN01132651 ►Client user satisfaction and utilization surveys conducted in project target areas (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 3.00 5.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 This indicator is measured yearly. Comments: IN01132653 ►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 20.00 47.80 80.00 9/25/2022 Page 5 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 This indicator is measured yearly. An average of 47.8% of grievances were addressed, thus surpassing the target for year 3 (40%). The field visits included review of the GRM manual, records and all the related Comments: documents, as well as interviews with the responsible personnel. IN01132655 ►Average patient satisfaction level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 69.00 76.80 65.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 Out of the PHCs in 6 governates under the project, the highest patients’ satisfaction percent score was in Elbeheira (81.8%) and the lowest in Alexandria (71.72%). The lowest components were generally of Comments: health education and service effectiveness. IN01132657 ►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 31-Dec-2021 15-May-2022 31-Dec-2023 The end target has been met and surpassed the planned target 3 years ahead of schedule Comments: IN01132660 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 31-Dec-2021 15-May-2022 29-Dec-2023 IN01132661 ►Targeted PHCs applying environmentally-positive energy and water efficiency measures (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 271.00 376.00 600.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 A needs assessment for energy saving light bulbs has been completed for three batches of PHCs Comments: IN01132662 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,788,360.00 1,058,800.00 3,400,000.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 9/25/2022 Page 6 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) IN01132663 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,788,360.00 1,058,800.00 3,400,000.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 Strengthen Secondary Level Healthcare IN01132646 ►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 31-Dec-2021 15-May-2022 31-Dec-2023 This indicator is measured yearly. This activity is still on hold until the finalization of the MOU between the Comments: UPA and MOHP. The MOU has been drafted and is currently in the final stages of approvals/clearnaces IN01132648 ►Targeted Hep C patients treated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,385,453.00 1,073,586.00 1,500,000.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 The year 4 target has been met, 3 years ahead of schedule. However, This activity is currently on hold due to the shortage of Hep C medications as a result of the delayed agreement between MOHP and UPA. Comments: An MOU between the two entities is currently in its final stages of approvals/clearances. IN01132650 Percent Female (Percentage, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 43.00 45.00 40.00 Date 20-Jun-2018 31-Dec-2021 15-May-2022 29-Dec-2023 IN01132652 ►Number of PHCs receiving National Accreditation Certification for healthcare quality (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 113.00 0.00 600.00 Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 The tool for accreditation has been published for both hospitals and primary healthcare centers. It is Comments: currently being verified by IVA. IN01132654 9/25/2022 Page 7 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) ►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 31-Dec-2021 15-May-2022 31-Dec-2023 The tool for accreditation has been published for both hospitals and primary centers. It is currently being Comments: verified by IVA. IN01132656 ►Number of plasma centers passing the PQI composite indicator. (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 28-Jan-2021 31-Dec-2021 15-May-2022 31-Dec-2023 Progress on this indicator is reliant on the finalization of MOU between MOHP and UPA Comments: IN01132658 ►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 0.00 250,000.00 Date 28-Jan-2021 31-Dec-2021 15-May-2022 31-Dec-2023 Progress on this indicator is reliant on the finalization of MOU between MOHP and UPA Comments: IN01132659 ►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 0.00 2.00 Date 28-Jan-2021 31-Dec-2021 15-May-2022 31-Dec-2023 MOHP PMU reports that this indicator is completed, however, official monitoring of this indicator is pending signing the updated contract between the IVA and MOHP. The contract will be finalized once the Comments: Bank team and MOHP PMU reach an agreement on extending the project's closing date. Institutional Capacity Building ad Project Management IN01132645 ►Project results published regularly on external MOHP website (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 Yes Yes Yes Date 02-Jul-2018 31-Dec-2021 15-May-2022 31-Dec-2023 9/25/2022 Page 8 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) End target achieved. Comments: Performance-Based Conditions IN01132664 ►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 PBCS 1.1, 1.2,1.3 Accreditation guidelines Value accomplished. PBC1.4 accomplished. PBC1.4 -- developed. pending verification pending verification Date -- 31-Dec-2021 15-May-2022 -- IN01132665 ►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 47.80 80.00 Date -- 31-Dec-2021 15-May-2022 -- IN01132666 ►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 73.60 100.00 Date -- 31-Dec-2021 15-May-2022 -- IN01132667 ►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 Value 0.00 271.00 376.00 -- Date -- 31-Dec-2021 15-May-2022 -- 9/25/2022 Page 9 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) IN01132668 ►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 17.80 32.00 Date -- 31-Dec-2021 15-May-2022 -- IN01132669 ►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 58.00 65.00 Date -- 31-Dec-2021 15-May-2022 -- IN01132670 ►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 52,000,000.00 -- Date -- 31-Dec-2021 15-May-2022 -- IN01132671 ►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 52,000,000.00 -- Date -- 31-Dec-2021 15-May-2022 -- IN01132672 ►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%) 9/25/2022 Page 10 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Baseline Actual (Previous) Actual (Current) Year 5 Value 0.00 70.00 72.80 70.00 Date -- 31-Dec-2021 15-May-2022 -- IN01132673 ►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 0.00 -- Date -- 31-Dec-2021 15-May-2022 -- IN01132674 ►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 Plasma Quality Tools Value 0.00 developed developed developed Date -- 31-Dec-2021 15-May-2022 -- IN01132675 ►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 0.00 -- Date -- 31-Dec-2021 15-May-2022 -- IN01132676 ►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 Value 0.00 0.00 0.00 12.00 Date -- 31-Dec-2021 15-May-2022 -- 9/25/2022 Page 11 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) IN01132677 ►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 0.00 -- Date -- 31-Dec-2021 15-May-2022 -- IN01132678 ►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 0.00 200,000.00 -- Date -- 31-Dec-2021 15-May-2022 -- 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 0.00 317.22 212.78 60% 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 9/25/2022 Page 12 of 13 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Restructuring History Level 2 Approved on 20-Jul-2021 Related Project(s) There are no related projects. 9/25/2022 Page 13 of 13