The World Bank Implementation Status & Results Report Samoa Health System Strengthening Program (P164382) Samoa Health System Strengthening Program (P164382) EAST ASIA AND PACIFIC | Samoa | Health, Nutrition & Population Global Practice | Requesting Unit: EACNF | Responsible Unit: HEAHN IBRD/IDA | Program-for-Results Financing | FY 2020 | Team Leader(s): Shuo Zhang, Carol Atieno Obure Seq No: 1 | ARCHIVED on 29-Jun-2020 | ISR41944 | Created by: Shuo Zhang on 21-May-2020 | Modified by: Shuo Zhang on 28-Jun-2020 Program Development Objectives Program Development Objective (from Program Appraisal Document) The Program Development Objective (PDO) is to improve the quality and efficiency of NCD prevention and control in Samoa. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO -- Moderately Satisfactory Overall Implementation Progress (IP) -- Moderately Satisfactory Implementation Status and Key Decisions The Samoa Health System Strengthening Program for Results was approved by the Board on December 5, 2019, the Financing Agreement was signed by the Government on February 28, 2020, and the Program became effective on May 27, 2020. A World Bank joint pre-effectiveness mission was conducted during February 24 to March 13, 2020 with the objectives to advance the Program progress, including the implementation of activities under Program Preparation Advance (PPA), and prepare for implementation after effectiveness. Good progress was made during the visit. Since October 2019, Samoa has been affected by two major disease outbreaks: a measles outbreak (State of Emergency from November 16 to December 28th 2019) and the COVID-19 pandemic (State of Emergency announced on March 20, 2020 and is still ongoing). The Government has devoted tremendous efforts to respond to these public health emergencies and as a result, the Program progress is impacted by some delays. Two Program Preparation Advance activities were cancelled as the selected candidate withdrew the bid due to the slow progress and travel restrictions; these two activities will be moved to the implementation stage. There are also delays in the activities planned to be carried out before July (the beginning of the Government’s Fiscal Year 2021) when the implementation commences. The key next steps are to accelerate the program implementation according to the implementation road-map; this includes development of the first year implementation action plan and submission to the Health Program Advisory Committee for review and clearance; development of the monitoring and evaluation framework; finalization of Program Operations Manual; finalization of the terms of reference for the multi-disciplinary team; development of health promotion programs; development of non-communicable diseases’ case management protocols, among others. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P164382 IDA-D5270 Effective USD 9.30 9.30 0.00 0.00 9.42 0% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date 6/29/2020 Page 1 of 11 The World Bank Implementation Status & Results Report Samoa Health System Strengthening Program (P164382) P164382 IDA-D5270 Effective 05-Dec-2019 28-Feb-2020 27-May-2020 31-Dec-2025 31-Dec-2025 DLI Disbursement Achievement Disbursed amount in Disbursement % for DLI ID DLI Type Description Coc DLI Amount Status Coc DLI Loan: IDAD5270-001 Percentage of children 1 Regular XDR 1,460,000.00 Not Achieved 0.00 screened as overw Number of districts with 2 Regular XDR 1,250,000.00 Not Achieved 0.00 PEN Fa'a Samoa Percentage of high-risk 3 Regular XDR 1,110,000.00 Not Achieved 0.00 people Number of rural district 4 Regular XDR 720,000.00 Not Achieved 0.00 hospitals with Percentage of 5 Regular hypertensive patients XDR 1,260,000.00 Not Achieved 0.00 mana Implementation completion 6 Regular XDR 510,000.00 Not Achieved 0.00 rate of annual PPF Preparation Advance to be 7 -- 590,000.00 -- 0.00 Refinancing repaid in acco Program Action Plan 1. Develop a systematic M&E framework for NCD control program and implement throughout the Program Action Description implementation. Source DLI# Responsibility Timing Timing Value Status Recurrent. The framework be adopted no later than three Technical MOH Other months after Effective In Progress date and be implemented accordingly thereafter. The draft M&E framework to be submitted to the World Bank for review no later than one month after Program Completion Measurement effectiveness date. Comments 2. Complete, issue and adopt the updated oganizational structure of MOH, which includes at least one functional unit, Action Description to be responsible for procurement, with mandate, composition, and resources. Source DLI# Responsibility Timing Timing Value Status Updated organizational Technical MOH Other In Progress structure of MOH be 6/29/2020 Page 2 of 11 The World Bank Implementation Status & Results Report Samoa Health System Strengthening Program (P164382) adopted no later than three months after Effective Date. Completion Measurement Submit to the Association the updated organizational structure of MOH for information. Comments 3. Create a new budget line item for Program identification under "Transactions on Behalf of the State" Category of Action Description MOH’s Budget, so that the country's financial information system can generate annual Program Budget & Expenditure Reports. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MOH and MOF Recurrent Yearly In Progress The system and the chart of account are updated by May 31, 2020, and are being used to generate the Program- Completion Measurement specific annual budget and expenditure reports thereafter. Comments Action Description 3. Personnel expenditures and indirect costs will be allocated to the Program in accordance with POM. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MOH and MOF Recurrent Yearly In Progress The system and the chart of account are updated by May 31, 2020, and are being used to generate the Program- Completion Measurement specific annual budget and expenditure reports thereafter. Comments 4. Ensure two performance audits for the Program are provided: one at the Program mid-term review and another by Action Description no later than 6 months before Program Closing Date. Source DLI# Responsibility Timing Timing Value Status Two audits during the implementation. Mid- Fiduciary Systems MOF and MOH Other Not Yet Due term and 6 months before Closing Date. Completion Measurement Audit report to be submitted to the Association 3 months after the Audit is completed Comments Action Description 5. . Ensure an audit opinion on the full scope of the Program Financial Statements is provided. Source DLI# Responsibility Timing Timing Value Status 6/29/2020 Page 3 of 11 The World Bank Implementation Status & Results Report Samoa Health System Strengthening Program (P164382) Recurrent. Yearly Fiduciary Systems MOF and MOH Other (maximum 9 months Not Yet Due after the end of the FY) Completion Measurement As demonstrated in the audited Financial Statement of the Program. Comments Action Description 6. Include and implement detailed procurement capacity building program under DLI6. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MOH Recurrent Yearly Not Yet Due Provide a summary in the semi-annual progress report on: Completion Measurement Procurement training provided or received including number of MOH staff completing formal procurement training (online, face to face). Comments 7. Ensure transparency of Procurement related actions by a) Publishing Program annual procurement plan on both Action Description MOF and MOH websites; b) Publishing on the MOF website the contracts awarded under the Program. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MOH and MOF Recurrent Yearly Not Yet Due Publication of Program annual procurement plan on both MOF and MOH websites. Completion Measurement Contracts awarded under the Program published on the MOF website including the availability of historical contract- award information (prior Financial Years). Comments 8. Implement and ensure the operation of the Pharmaceutical Logistics Information Management System, which will Action Description be used to procure the NCD drugs. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MOH and MOF Other June 30, 2020 In Progress Completion Measurement The Association will conduct site investigation upon confirmation from the MOH of the system operationalization. Comments Action Description 9. Procure and commission waste management/treatment infrastructure as recommended by the HCWM review. Source DLI# Responsibility Timing Timing Value Status 6/29/2020 Page 4 of 11 The World Bank Implementation Status & Results Report Samoa Health System Strengthening Program (P164382) Environmental and Social MOH Other By December 31, 2020 Not Yet Due Systems Waste management/treatment infrastructure commissioned and operational, as evidenced by satisfactory audit Completion Measurement findings. Comments Action Description 10. Develop/update and implement the Implementation Plan of HCWM Policy and HCWM Strategy. Source DLI# Responsibility Timing Timing Value Status Recurrent. The National Policy and Implementation plan be Environmental and Social MOH Other formulated by end of In Progress Systems 2019, and be implemented accordingly thereafter. By March 31, 2020: Implementation Plan for HCWM Strategy for both Upolu and Savai’I are submitted to the Bank for Completion Measurement review and clearance. Comments 11. HCWM Staff receive training on HCWM, OSH and environmental health as part of HPAC-approved Annual Action Description Capacity Building Plan (DLI6). Source DLI# Responsibility Timing Timing Value Status Environmental and Social MOH Recurrent Yearly Not Yet Due Systems Report in the semi-annual progress report the HCWM/environment health training received including number of MOH Completion Measurement staff completing training (online, face to face and etc.). Comments 12. Manage Social impacts by (a) Implementing the grievance process and (b) Considering the vulnerable groups. Action Description Source DLI# Responsibility Timing Timing Value Status Environmental and Social MOH Other Yearly when applicable Not Yet Due Systems Submission to the Association in the semi-annual progress report: a) Evidence of implementation of grievance process, including report on the number of grievances received, Completion Measurement timeliness of resolutions. 6/29/2020 Page 5 of 11 The World Bank Implementation Status & Results Report Samoa Health System Strengthening Program (P164382) Comments 13. Land access- For any proposed site where land leases are required which has not previously been in the control Action Description of MOH. (a) undertake screening for impacts including brief assessment of physical and livelihood impacts. Source DLI# Responsibility Timing Timing Value Status Recurrent. Report Environmental and Social MOH and MNRE Other where there is land Not Yet Due Systems acquisition. Land access information (if any) to be reported in the semi-annual program progress report, including lease Completion Measurement agreement letters signed by land owners, compensation agreement and payment, records of impact screening. Comments 13. Land access- For any proposed site where land leases are required which has not previously been in the control Action Description of MOH. (b) Consultation with the land owner is required and must be documented. Source DLI# Responsibility Timing Timing Value Status Recurrent. Report Environmental and Social MOH and MNRE Other where there is land Not Yet Due Systems acquisition. Completion Measurement The Association will review the records and may conduct on-site review during the implementation support missions. Comments 13. Land access-For any proposed site where land leases are required which has not previously been in the control Action Description of MOH. (c) Evidence of compensation arrangements including assessment of value, payment of compensation consultation with affected land Source DLI# Responsibility Timing Timing Value Status Recurrent. Report Environmental and Social MOH and MNRE Other where there is land Not Yet Due Systems acquisition. Completion Measurement The Association will review the records and may conduct on-site review during the implementation support missions. Comments Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating 6/29/2020 Page 6 of 11 The World Bank Implementation Status & Results Report Samoa Health System Strengthening Program (P164382) Political and Governance Substantial -- Moderate Macroeconomic Moderate -- Moderate Sector Strategies and Policies Moderate -- Moderate Technical Design of Project or Program Moderate -- Moderate Institutional Capacity for Implementation and High -- High Sustainability Fiduciary Substantial -- Substantial Environment and Social Moderate -- Moderate Stakeholders Moderate -- Moderate Other Moderate -- Moderate Overall High -- High RiskComments Comments The rating for Political and governance has been upgraded to Moderate from Substantial as the landmark reorganization to integrate the formal National Health Services with Ministry of Health has been completed and the integrated structure is in place and functioning Results PDO Indicators by Objectives / Outcomes Result Area 1. Address behavioral risk factors through population-based health promotion IN00848079 ►1.Percentage of children ages 5-12 years, screened as overweight through school nurse program, who are referred to and managed under a health promotion program (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 70.00 Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 Numerator: Number of children classified as overweight, referred and managed under a health promotion Comments program. Denominator: Total number of children aged 5 -12 years screened in school as overweight. Result Area 2. Increase screening, referral and diagnosis of NCD high-risk group and NCD patients IN00848081 ►4. Number of districts with PEN Fa’a Samoa rolled out according to the updated protocol (at least 70% of citizens, and at least 60% of men, aged 20 years old and older in the district screened) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 -- 2.00 26.00 Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 Number of Districts with Pen Fa’a Samoa screening implemented. At least 70% of the citizens ≥20 years old Comments and at least 60% of men ≥20 years old in the district must be screened for it to be qualified as completed. IN00848083 ►5. Percentage of NCD high risk people, identified through Pen Fa’a Samoa screening, who are diagnosed within 60 days at designated health facility (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/29/2020 Page 7 of 11 The World Bank Implementation Status & Results Report Samoa Health System Strengthening Program (P164382) Value 0.00 -- 0.00 70.00 Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 Numerator: Number of NCD high risk people identified, presented to a health facility within 60 days for Comments diagnosis Denominator: Total number of residents screened as high-risk group for NCDs. Result Area 3. Strengthen primary care and quality of NCD management IN00848080 ►7. Percentage of hypertensive patients, managed by rural health facilities, who have their condition under control following WHO definition (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 19.00 -- 19.00 70.00 Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 Numerator: number of hypertensive patients, managed by the district hospitals following standardized disease management protocols, who have their blood pressure under control. WHO definition will be used Comments to define the blood pressure is under control. Denominator: number of hypertensive patients, managed by the district hospitals following standardized disease management protocols. Result Area 4. Strengthen multisectoral NCD program stewardship and build institutional capacity IN00848082 ►12. Percentage of health sector budget allocated to primary health care and health promotion (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 15.00 -- 15.00 15.00 Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 Numerator: annual health sector budget allocated to primary health care and health promotion Denominator: Comments total health sector budget Intermediate Results Indicators by Results Areas Result Area 1. Address behavioral risk factors through population-based health promotion IN00848084 ►2. Percentage of residents in Pen Fa’ a Samoa districts with improved knowledge and awareness of NCD risk factors, disaggregated by gender (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 70.00 Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 The residents screened in PEN Fa’a Samoa screening are assessed on their knowledge and awareness of NCD risk factors during the screening and one year after the screening. Numerator: total number of Comments screened residents who have improved knowledge and awareness. Denominator: total number of residents screened. IN00848088 ►3. Percentage of primary schools, identified in the previous year inspection as non-compliant with School Nutrition Standards, becoming compliant. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 6/29/2020 Page 8 of 11 The World Bank Implementation Status & Results Report Samoa Health System Strengthening Program (P164382) Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 Numerator: number of primary schools, identified in the previous year inspection as non-compliant with Comments School Nutrition Standards, becoming compliant. Denominator: total number of primary schools identified in the previous year inspection as non-compliant with School Nutrition Standards. Result Area 2. Increase screening, referral and diagnosis of NCD high-risk group and NCD patients. IN00848086 ►6. Percentage of non-NCD patients aged 20 and above, who present to a rural health facility, screened for NCD annually (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 60.00 Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 Numerator: number of non-NCD patients aged 20 and above screened at rural health facility for NCDs Comments Denominator: total number of non-NCD patients aged 20 and above presented at rural health facility Result Area 3. Strengthen primary care and quality of NCD management IN00848087 ►8. Number of rural district hospitals/health centers with a multi-disciplinary team in place (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 0.00 Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 Comments Number of rural district hospitals staffed with multidisciplinary team according to the defined TORs IN00848089 ►9. Percentage of patients in the hypertension and Diabetes registry tracked and managed by rural health facilities following standardized disease management protocols, disaggregated by gender (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 60.00 Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 Numerator: number of registered hypertension and diabetic patients followed up and managed by rural Comments health facilities Denominator: total number of registered hypertension and diabetic patients IN00848090 ►10. Percentage of people, identified as high-risk through screening, tracked and managed by rural health facilities following standardized protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 55.00 Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 Numerator: number of NCD high-risk people tracked and managed by rural health facilities following Comments standardized protocols Denominator: total number of people, identified as high-risk through screening IN00848091 ►11. (Reduction of) Stock-outs (more than 2 weeks) of all essential drugs in rural health facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/29/2020 Page 9 of 11 The World Bank Implementation Status & Results Report Samoa Health System Strengthening Program (P164382) Value 40.00 -- 40.00 20.00 Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 Numerator: number of essential medicines in rural health facilities that were out of stock for more than 4 Comments months in a year Denominator: total number of essential medicines in rural health facilities in accordance with Essential Medicines List. Result Area 4. Strengthen multisectoral NCD program stewardship and build institutional capacity IN00848085 ►13. Implementation completion rate of Annual Capacity Building Plan for NCD program approved by the HPAC (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 70.00 Date 01-Jan-2018 -- 26-Jun-2020 30-Jun-2025 Numerator: number of capacity building activities in the Annual Capacity Building Plan that have been fully implemented and completed according to the completion format / standard defined in the Plan. Comments Denominator: number of capacity building activities defined in the Annual Capacity Building Plan for NCD program approved by the Samoa Health Program Advisory Committee (HPAC). Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 DLI 1: Percentage of children ages 5-12 years, screened as overweight through school nurse program, referred to and managed under a health promotion program (Intermediate Outcome, 1,980,000.00, 0%) Baseline Actual (Previous) Actual (Current) June 30, 2025 Value 0.00 -- 0.00 70.00 Date -- -- 26-Jun-2020 -- The implementation has yet to start. It will start in July 2020 Comments ►DLI 2 DLI 2: Number of districts with PEN Fa’a Samoa rolled out according to the updated protocol (at least 70% of citizens and at least 60% of men, aged 20 years old and older in the district screened). (Output, 1,680,000.00, 0%) Baseline Actual (Previous) Actual (Current) June 30, 2025 Value 2.00 -- 2.00 26.00 Date -- -- 26-Jun-2020 -- The implementation has yet to start. It will start in July 2020 Comments ►DLI 3 DLI 3. Percentage of high-risk people identified through PEN Fa'a Samoa screening are diagnosed within 60 days at designated health facility (Outcome, 1,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) June 30, 2025 Value 0.00 -- 0.00 70.00 6/29/2020 Page 10 of 11 The World Bank Implementation Status & Results Report Samoa Health System Strengthening Program (P164382) Date -- -- 26-Jun-2020 -- The implementation has yet to start. It will start in July 2020 Comments ►DLI 4 DLI 4: Number of rural district hospitals with a multi-disciplinary team in place (Outcome, 960,000.00, 0%) Baseline Actual (Previous) Actual (Current) June 30, 2025 Value 0.00 -- 0.00 0.00 Date -- -- 26-Jun-2020 -- Comments ►DLI 5 DLI 5: Percentage of hypertensive patients, managed by the rural health facilities, who have their condition under control following WHO definition (Outcome, 1,700,000.00, 0%) Baseline Actual (Previous) Actual (Current) June 30, 2025 Value 19.00 -- 19.00 75.00 Date -- -- 26-Jun-2020 -- The implementation has yet to start. It will start in July 2020 Comments ►DLI 6 DLI 6: Implementation Completion Rate of Annual Capacity Building Plan for NCD program approved by HPAC (Outcome, 680,000.00, 0%) Baseline Actual (Previous) Actual (Current) June 30, 2025 Value 0.00 -- 0.00 70.00 Date -- -- 26-Jun-2020 -- The implementation has yet to start. It will start in July 2020 Comments 6/29/2020 Page 11 of 11