The World Bank ESV:Addressing Non-Communicable Diseases (P164356) REPORT NO.: RES50447 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF ESV:ADDRESSING NON-COMMUNICABLE DISEASES PROJECT (P164356) APPROVED ON SEPTEMBER 13, 2018 TO REPUBLIC OF EL SALVADOR HEALTH, NUTRITION & POPULATION GLOBAL PRACTICE LATIN AMERICA AND CARIBBEAN REGION Regional Vice President: Carlos Felipe Jaramillo Country Director: Michel Kerf Global Director: Juan Pablo Eusebio Uribe Restrepo Practice Manager/Manager: Michele Gragnolati Task Team Leader(s): Amparo Elena Gordillo-Tobar, Roberto F. Iunes The World Bank ESV:Addressing Non-Communicable Diseases (P164356) ABBREVIATIONS AND ACRONYMS CKD Chronic Kidney Disease DM Diabetes Mellitus PHGF Pharmaceutical Governance Fund HPV Human Papillomavirus IP Implementation Progress MINSAL Ministry of Health NCDs Noncommunicable Diseases PDO Project Development Objective The World Bank ESV:Addressing Non-Communicable Diseases (P164356) BASIC DATA Product Information Project ID Financing Instrument P164356 Investment Project Financing Original EA Category Current EA Category Approval Date Current Closing Date 13-Sep-2018 28-Feb-2022 Organizations Borrower Responsible Agency Republic of El Salvador Ministry of Health Financing (in USD Million) FIN_SUMM_PUB_TBL SUMMARY Total Project Cost 0 Total Financing 0 Financing Gap 0 DETAILS -NewFin3 Project Development Objective (PDO) Original PDO The objective of the Project is to support the Government of El Salvador in piloting an integrated health care service delivery model to improve the prevention, early detection, and treatment of cervical cancer as well as the prevention of NCD risk factors in selected regions of El Salvador. OPS_TABLE_PDO_CURRENTPDO The World Bank ESV:Addressing Non-Communicable Diseases (P164356) Summary Status of Financing (US$, Millions) Net TF Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed TF-A8267 03-Aug-2018 19-Dec-2018 19-Dec-2018 28-Feb-2022 1.80 1.80 0 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING 1. The objective of the El Salvador Addressing Noncommunicable Diseases Project (P164356) is to support the Government of El Salvador in piloting an integrated health care service delivery model to improve the prevention, early detection, and treatment of cervical cancer as well as the prevention of Noncommunicable Diseases (NCD) risk factors in selected regions of El Salvador. 2. The Project is funded by the Pharmaceutical Governance Fund (PHGF) and the donation agreement (TF0A8267) was signed on December 19, 2018, for a total of US$1.8 million and original closing date of March 31, 2020. The project has disbursed 100 percent with Satisfactory ratings for both, Progress toward achievement of the Project Development Objective (PDO), and overall Implementation Progress (IP). The closing date of the Project was extended once in March 2020 from March 31, 2020 to February 28, 2022. 3. The Project has supported the Ministry of Health (MINSAL) in the pilot testing of an integrative model of health service delivery to improve the prevention, early detection and treatment of cervical cancer, as well as the prevention of risk factors for NCDs. This donation is benefiting a total of 82,114 women aged 30 to 59 years with the Human Papillomavirus (HPV) test, and about 539,781 people with interventions aimed at the early detection and timely management of other NCDs, in the geographical areas of the Western Regions, Central and Paracentral. 4. The Project components are: (i) Health service delivery model for the prevention, early detection and treatment of NCDs, (ii) Innovations in the prevention of risk factors, and (iii) Monitoring and Management of the Pilots. Key Project achievements include: a) Development of an integrative model of health care service delivery for NCD patients, emphasizing people with cervical cancer. The development of a service delivery model that integrates various interventions for the prevention, early detection and treatment of NCDs, emphasizing people with cervical cancer and includes the detection test for HPV. A total of 49,088 women aged 30-59 years of age were tested for HPV, which 6,254 reported HPV+ a positivity percentage of 12.8 percent (Central region 12,6 percent and Paracentral 13.0 percent). Out of these women 4,299 (68.74 percent of the target of 70 percent) were treated with cryotherapy or referred for colposcopy or more complex treatment. The World Bank ESV:Addressing Non-Communicable Diseases (P164356) b) Innovations in the prevention of risk factors related to noncommunicable diseases. The Project supported the introduction of innovations in the delivery of strategies aimed primarily at the promotion and prevention of cervical cancer through the application of HPV vaccine; the implementation of an information, communication and education strategy developed at different levels of health care. As of December 2021, a total of 17,778 girls 9-10 years of age (surpassed target of 14,000 girls) had been vaccinated with the first doses of HPV vaccine: 7,313 in the Central Region, 8,148 in the Paracentral Region and 2,317 in the Oriental Region. A total of 38,442 blood chemistry tests were performed, including Glycemia, Glycosylated HB, Creatinine, Cholesterol and Triglycerides for the screening of people aged 30 to 69 years with risk factors for Diabetes Mellitus (DM), dyslipidemia and Chronic Kidney Disease (CKD); timely identifying 3,640 people with DM and dyslipidemia in the population aged 30 to 69 years. At the same time, 1,701 people with risk factors (hypertension, DM, recurrent urinary tract infection, renal lithiasis, exposure to nephrotoxic substances including pesticides, among others) were diagnosed for first time with CKD out of 1,795 identified with the conditions (94.8 percent sur surpassed the 50 percent target). c) Development and printing of educational material for the comprehensive approach of NCDs, included: Triptychs: Breast Cancer 50,000, Colon Cancer 50,000, Stomach Cancer 50,000, Cervical Cancer and HPV Test 50,000, Prostate Cancer 50,000. A. Rationale for restructuring. 5. NCDs are the main cause of disease and preventable premature death in El Salvador, representing by 2021 52.9 percent of total deaths, of which 39 percent are in the population between 30-69 years old. Their heavy social and economic burden, especially the sharp increase in treatment costs and the loss of productivity, undermines individual, family and community well-being, threatening to hinder social and economic development. 6. A new Grant from the Pharmaceutical Governance Fund (PHGF) in the amount of US$750,000 has been approved by the Donors to support the Government of El Salvador to expand the pilot program of the integrated provision of NCDs to three additional health networks. 7. On February 25, 2022, the Minister of Finance requested a second extension of the grant closing date for one month from February 28, 2022 to March 30, 2022 to allow enough time to prepare a full Level 2 Project restructuring/additional financing package to receive the additional funds, expand the Project scope, and organize the work in the new communities and process another extension of the project closing date in order to implement the additional funds. The performance of the Recipient remains Satisfactory taking into account that project activities have progressed well. Also, Procurement, Financial Management and Safeguards have Satisfactory ratings, and MINSAL’S implementing unit has been very effective coordinating Project implementation. 8. The Recipient does not have any outstanding audit reports nor audit reports which are not satisfactory to the Bank. Finally, the Project Development Objectives remain achievable and relevant. The World Bank ESV:Addressing Non-Communicable Diseases (P164356) II. DESCRIPTION OF PROPOSED CHANGES 9. If approved, this Level 2 Project restructuring will extend the Project closing date for one month, from February 28, 2022, to March 30, 2022 to allow enough time to prepare a full restructuring to add additional funding and expand the NCD pilot program to three health networks. On that period, another extension of closing date will be processed through a level 2 restructuring/additional financing. III. SUMMARY OF CHANGES Changed Not Changed Loan Closing Date(s) ✔ Disbursement Estimates ✔ Implementing Agency ✔ Project's Development Objectives ✔ Results Framework ✔ Components and Cost ✔ Cancellations Proposed ✔ Additional Financing Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Change in Overall Risk Rating ✔ Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ The World Bank ESV:Addressing Non-Communicable Diseases (P164356) Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline TF Status Closing Closing(s) Closing for Withdrawal Applications TF-A8267 31-Mar-2020 28-Feb-2022 30-Mar-2022 30-Jul-2022 OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Change in Disbursement Estimates Yes Expected Disbursements (In US$) Fiscal Year Annual Cumulative 2018 0.00 0.00 2019 50,000.00 50,000.00 2020 0.00 50,000.00 2021 0.00 50,000.00 2022 0.00 50,000.00