The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) Uttarakhand Health Systems Development Project (P148531) SOUTH ASIA | India | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 10 | ARCHIVED on 28-Jun-2021 | ISR46948 | Implementing Agencies: Republic of India, Department of Medical Health and Family Welfare, Government of Uttarakhand Key Dates Key Project Dates Bank Approval Date: 26-Jan-2017 Effectiveness Date: 23-May-2017 Planned Mid Term Review Date: 31-Jul-2020 Actual Mid-Term Review Date: 26-Oct-2020 Original Closing Date: 30-Sep-2023 Revised Closing Date: 30-Sep-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to improve access to quality health services, particularly in the hilly districts of thestate, and to expand health financial risk protection for the residents of Uttarakhand 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) To improve access to quality health services in the State of Uttarakhand. Components Table Name Innovations in engaging the private sector:(Cost $42.50 M) Stewardship and system improvement component:(Cost $45.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions Despite the challenges due to COVID-19 pandemic, the project has shown significant progress since the Mid-term Review (MTR) in October 2020. While disbursements have doubled since the MTR (from USD 6.4 million in October 2020 to USD 12.9 million in April 2021), commitments have also increased from 72% in October 2020 to 81% in April 2021. With additional procurement processes underway, commitments are expected to reach 95% by the end of June 30, 2021. The project implementation team is also better staffed with around 75% staff in place and state is in process of filling up remaining positions soon. With most of project funds committed, activities underway and staff in place, project is expected to continue with good progress in the future. Overall, the Implementation Support Mission found project implementation to have substantially improved and noted that it is on an accelerated track and indicated good progress since the MTR in October 2020. The restructuring of the PDO, components 6/28/2021 Page 1 of 7 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) and results framework will further help consolidate implementation and accelerate disbursements. The mission recommends retaining the project ratings to “Moderately Satisfactory” for “Achievement of the PDO” and noting the acceleration in implementation of the project the Implementation Progress” ratings are upgraded to “Satisfactory”. 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 -- Moderate Moderate Sustainability Fiduciary -- Substantial Substantial Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Moderate Moderate Results PDO Indicators by Objectives / Outcomes Innovations in engaging the private sector IN00999924 ►Number of outpatient visits to Primary Health Centers (PHCs), CHCs, and mobile vans per year, disaggregated by districts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 774,926.00 1,165,548.00 2,489,812.00 1,232,128.00 Date 31-Mar-2016 30-Sep-2020 31-Mar-2021 31-Mar-2023 Data for April-2020 to March 2021 Comments: IN00999925 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target 6/28/2021 Page 2 of 7 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) Value 139,855.00 139,855.00 82,694.00 180,491.00 Date 31-Mar-2020 31-Mar-2020 31-Mar-2021 31-Mar-2023 Data is for April 2020 to March 2021 for facilities under PPP and NABH clusters under the project. Number of deliveries at health facilities under the project interventions are lower compared to the target primarily due to COVID-19 pandemic. Some of the facilities were converted to COVID-19 hospitals and Comments: hence non-COVID services were hampered at these facilities. IN00999927 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 139,855.00 139,855.00 81,694.00 180,491.00 Date 31-Mar-2020 31-Mar-2020 31-Mar-2021 31-Mar-2023 Stewardship and system improvement component IN00999926 ►Number of Government healthcare facilities in the state issued with an entry (or higher) level certification by the National Accreditation Board for Hospitals (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 1.00 9.00 Date 30-Sep-2017 30-Sep-2020 31-Mar-2021 31-Mar-2023 Data as on March 31, 2021. This indicator has been revised. Earlier indicator included accredited facilities in the private sector and hence the reported number was 4 (facilities in the private sector with NABH Comments: accreditation); however, revised indicator captures facilities with NABH accreditation in govt sector only and there is only one facility of the govt which has NABH accreditation as on March 31, 2021. Intermediate Results Indicators by Components Innovations in engaging the private sector IN00999930 ►No. of OPDs done by MHVs under PPP clusters, disaggregated by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 12,247.00 6,395.00 20,000.00 Date 31-Mar-2019 31-Mar-2020 31-Mar-2021 31-Mar-2023 Data for - April-2020 to March-2021 Total: 6,395; Female: 3,837; Male: 2,558 Comments: Progress is lower than expected due to the COVID-19 pandemic as MHVs were not operational during the peak of the pandemic. IN00999933 6/28/2021 Page 3 of 7 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) ►Proportion of female patients availed MHV services for Hb testing under PPP clusters (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 60.00 49.00 90.00 Date 31-Mar-2019 31-Mar-2020 31-Mar-2021 31-Mar-2023 Reported progress is lower than the target for this FY (i.e. 70%) primarily due to the COVID-19 pandemic when regular MHV services were not available throughout the year and fewer people availed of these Comments: services. With a lower denominator, the proportions are likely to fluctuate and don’t fully reflect the progress. IN00999935 ►No. of PPP health facilities operational on 24*7 basis for consultation, admission and referral (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 9.00 9.00 Date 31-Mar-2019 30-Sep-2020 31-Mar-2021 31-Mar-2023 Data as of March 31, 2021 Comments: IN00999937 ►Number of outsourced CHCs where at least one emergency caesarean section was reported during each quarter (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 2.00 6.00 Date 31-Mar-2019 30-Sep-2020 31-Mar-2021 31-Mar-2023 Data for - April-2020 to March-2021 Comments: IN00999939 ►Number of specialists working in facilities supported by UKHSDP (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 30.00 59.00 112.00 Date 31-Mar-2019 30-Sep-2020 31-Mar-2021 31-Mar-2023 Data as of March 31, 2021 Comments: IN00999940 ►No of patients using telemedicine consultation in the state (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 81,560.00 4,800,000.00 Date 31-Mar-2020 31-Mar-2020 31-Mar-2021 31-Mar-2023 Comments: Data as of March 31, 2021 6/28/2021 Page 4 of 7 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) Stewardship and system improvement component IN00999928 ►Health personnel receiving training financed by the project- cumulative (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 7,796.00 10,032.00 11,065.00 Date 31-Mar-2016 30-Sep-2020 31-Mar-2021 31-Mar-2023 Data as of March 31, 2021 Comments: IN00999929 ►Development and periodical update of a comprehensive disaster response plan at the state level (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 25-Nov-2016 30-Sep-2020 31-Mar-2021 31-Mar-2023 PIT is under the process of hiring an agency to develop a disaster management plan for the state - EOI Comments: has been issued and the firm is expected to be on board by July 2021. IN00999931 ►Number of functional ICU beds in the state [cumulative] (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 216.00 216.00 216.00 900.00 Date 31-Mar-2020 31-Mar-2020 31-Mar-2021 31-Mar-2023 Additional 170 ICU beds are being established. Comments: IN00999932 ►Number of health facilities using e-hospital online platform for service delivery, data collection and reporting (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 31-Mar-2020 31-Mar-2020 31-Mar-2021 31-Mar-2023 Procurement for the HMIS development agency underway and expected to close by July 2021. Comments: IN00999934 ►Proportion of facilities supported by the project under PPP and NABH cluster with at least 80% adherence to Standard Treatment Protocols (STPs) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 10.00 40.00 80.00 6/28/2021 Page 5 of 7 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) Date 31-Mar-2020 31-Mar-2020 31-Mar-2021 31-Mar-2023 Data as on March 31, 2021 Comments: IN00999936 ►Number of COVID-19 testing labs in the state [cumulative] (Months, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 5.00 7.00 Date 31-Mar-2020 31-Mar-2020 31-Mar-2021 31-Mar-2023 As on March 31, 2021 Comments: IN00999938 ►Proportion of families covered under Family Health Survey (FHS) and their record digitized (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 100.00 90.00 Date 31-Mar-2020 31-Mar-2020 31-Mar-2021 31-Mar-2023 All families have been surveyed and their data reorded Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P148531 IDA-59480 Effective USD 100.00 70.00 30.00 17.47 52.53 25% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P148531 IDA-59480 Effective 26-Jan-2017 23-Mar-2017 23-May-2017 30-Sep-2023 30-Sep-2023 Cumulative Disbursements 6/28/2021 Page 6 of 7 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) 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 29-Oct-2020 ,Level Approved on 30-Oct-2020 ,Level 2 Approved on 20-Apr-2021 Related Project(s) There are no related projects. 6/28/2021 Page 7 of 7