The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Comprehensive Approach to Health System Strengthening (P166013) AFRICA EAST | Comoros | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 4 | ARCHIVED on 22-Apr-2021 | ISR46235 | Implementing Agencies: UNION OF COMOROS, MINISTRY OF HEALTH, SOLIDARITY, SOCIAL PROTECTION AND GENDER PROMOTION Key Dates Key Project Dates Bank Approval Date: 02-Jul-2019 Effectiveness Date: 17-Apr-2020 Planned Mid Term Review Date: 11-Jul-2022 Actual Mid-Term Review Date: Original Closing Date: 30-Sep-2024 Revised Closing Date: 30-Sep-2025 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) (i) To improve utilization of quality PHC and (ii) strengthen capacity of institutions which are critical to quality PHC 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) (i) To improve utilization of quality PHC, (ii) to strengthen capacity of institutions which are critical to quality PHC and (iii) to provide immediate and effective response to an Eligible Crisis or Emergency Components Table Name Improving Primary Health Care Infrastructure, Workforce and Service Delivery Platforms:(Cost $22.00 M) Strengthening institutions and governance which are critical to (i) quality PHC and (ii) response to disease outbreaks:(Cost $5.00 M) Citizen Engagement and Empowerment, Project Management, Monitoring and Evaluation,:(Cost $3.00 M) Contingent Emergency Response Component:(Cost $5.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The project became effective on April 17, 2020, following which, the Contingent Emergency Response Component (CERC) was activated on April 30, 2020 to support the Union of Comoros in implementing its COVID-19 Preparedness and Response. Additional Financing was approved on August 20, 2020 to replenish the funds reallocated to the CERC. Overall, project implementation has been progressing well however, the pace of 4/22/2021 Page 1 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) implementation has been affected by the COVID-19 pandemic and some activities have slowed down. The Grievance Response Mechanism has been available to the public since October 2020 to ensure project accountability. The project’s Steering Committee has been operational since November 2020 and has approved the key working documents and provided overall guidance to the Project Implementation Unit (PIU). To enhance implementation, coordination teams in islands have been put in place since early January 2021, which has allowed a more effective follow-up and monitoring of project activities. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High Moderate Moderate Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and High High High Sustainability Fiduciary High Substantial Substantial Environment and Social Moderate Substantial Substantial Stakeholders Moderate Moderate Moderate Other -- -- -- Overall High Substantial Substantial Results PDO Indicators by Objectives / Outcomes (i)Improve utilization of quality PHC(ii)strengthen capacity of institutions(iii)provide immediate IN00978270 ►PHC facilities with accreditation level 2 above as per the facility accreditation program (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40.00 Date 31-Dec-2017 30-Jun-2020 30-Jun-2020 30-Sep-2024 This will be measured when the PBF activities are implemented, starting on the 2nd semester of 2021. Comments: IN00978471 ►PHC facilities participating in the PBF scheme supported by the project which reimburses for both quantity and quality of service (Number, Custom) 4/22/2021 Page 2 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 31-Dec-2017 30-Jun-2020 30-Jun-2020 30-Sep-2024 This will be measured when the PBF activities are implemented, starting on the 2nd semester of 2020. Comments: IN00978472 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 18,374.00 49,881.00 106,500.00 Date 31-Dec-2017 30-Jun-2020 28-Feb-2021 30-Sep-2024 The 2020 and final target will potentially be met Comments: IN00978473 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 9,357.00 17,954.00 15,000.00 Date 31-Dec-2018 30-Jun-2020 28-Feb-2021 30-Sep-2024 IN00978474 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 15,191.00 75,000.00 Date 31-Dec-2018 30-Jun-2020 28-Feb-2021 30-Sep-2024 IN00978475 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 9,017.00 16,736.00 16,500.00 Date 31-Dec-2018 30-Jun-2020 28-Feb-2021 30-Sep-2024 IN00978476 ►Functional community health sites (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 69.00 0.00 69.00 172.00 Date 31-Oct-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 IN00978477 ►Annual District and National Health Assemblies (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 4/22/2021 Page 3 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Value 0.00 0.00 0.00 18.00 Date 31-Oct-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 This activity requires people gathering, which is not possible due to the second wave of COVID-19. Comments: Those assemblies will be done as soon as possible. IN00978478 ►Percentage of identified close contacts of confirmed COVID-19 cases investigated based on national guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 54.00 100.00 80.00 Date 15-May-2020 30-Jun-2020 31-Dec-2020 31-Dec-2022 Achievement of the indicator is below to the target. The low level of achievement would be primarily Comments: related to the difficulties in reporting this indicator. (Data as of June 2020) Intermediate Results Indicators by Components Component 1 Improving PHC infrastructure, workforce and service delivery platforms IN00978479 ►PHC facilities renovated (minor renovations) and/or equipped among the PHC structures in need of these renovations and/or equipment (percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 The prerequisites for this indicator (finalization of the norms related to the rehabilitations and equipment Comments: have not yet been met). This is planned to begin by early September 2021. IN00978483 ►PHC health workers receiving annual CME (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 There has not yet been any continuing education funded by the project. In view of the current health crisis Comments: related to the COVID-19 pandemic, the Project is planning to conduct CME as early as next year. IN00978487 ►Revision of the pre-service nurse training curriculum to make it competency-based (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes 4/22/2021 Page 4 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 The prerequisites for this indicator have not yet been met. Comments: IN00978491 ►Recipients of scholarships for pre-service training in selected clinical disciplines, public health and health management (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 35.00 Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 Due to the pandemic context, recipients could not be enrolled for the last academic year. Comments: IN00978494 ►Community health workers trained to provide health and nutrition services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 102.00 516.00 Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 . Comments: IN00978496 ►PHC facilities with at least one quality improvement initiative with the team based problem solving approach (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 60.00 Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 This indicator will be measured when the PBF activities begin, during the second semester of 2021 Comments: IN00978497 ►Functional Emergency Medical Transportation with a dedicated hotline on each island (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 5.00 Date 31-Dec-2017 30-Jun-2020 28-Feb-2021 30-Sep-2024 The transportation aspect is solved as the ambulances have been acquired. The hotline is being set up Comments: Component 2 Strengthening institutions and governance which are critical to (i) quality PHC and (ii) IN00978480 ►National Health Strategies and Plans adopted (Quality of Care, NCDs, Human Resources for Health) (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 4/22/2021 Page 5 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Value 0.00 0.00 1.00 3.00 Date 30-Jun-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 The Ministry of Health is currently finalizing the development of the initial and continuing education Comments: strategy. The target that was set in the first year of implementation will be met. IN00978484 ►PHC health workers benefiting from annual clinical mentorship and/or coaching (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 Internal discussions within the MoH are in progress. The prerequisites for reporting this indicator are not Comments: yet in place IN00978488 ►PHC facilities self-monitoring a set of quality of care indicator quarterly for quality improvement (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 The prerequisites for reporting this indicator are not yet in place. Comments: IN00978492 ►Membership of health professional associations (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 15.00 100.00 Date 31-Dec-2017 30-Jun-2020 15-Feb-2021 30-Sep-2024 Component 3 Citizen Engagement and Empowerment, Project Management, Monitoring and Evaluation IN00978481 ►Operational hotline for patient complaints and feedbacks (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 IN00978485 ►Patient associations/support groups established (diabetes, hypertension, chronic lung diseases, cancer) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 4/22/2021 Page 6 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 Discussions are in progress to establish associations and support groups. Comments: IN00978489 ►Primary health care facilities submitting monthly report according to national guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 37.00 70.00 Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 The Direction de l’information et statistique sanitaire (DISS) does not have a reporting mechanism for this indicator. The UGP will support the DISS in putting in place a tool and mechanisms to be able to report Comments: on this indicator. The indicator will be reported from the last quarter of 2020. IN00978493 ►Nationally representative patient experience surveys conducted (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2.00 Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Sep-2024 This survey was supposed to be implemented during the first quarter of 2021. It could not have been implemented due to the COVID-19. Technical preparations are continuing and it is rescheduled for Comments: September 2021. IN00978495 ►Complaints for grievances timely addressed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 100.00 75.00 Date 31-Dec-2017 30-Jun-2020 28-Feb-2021 30-Sep-2024 Component 4 Contingent Emergency Response Component (CERC) IN00978482 ►Emergency Action Plan validated (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Emergency Action Plan Value Yes Yes Yes prepared Date 31-Dec-2019 30-Jun-2020 28-Feb-2021 30-Jun-2020 Target met Comments: IN00978486 ►Number of designated GeneXpert center with SARS-CoV-2 diagnostic capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 4/22/2021 Page 7 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) Value 0.00 2.00 2.00 2.00 Date 15-May-2020 30-Jun-2020 28-Feb-2021 31-Dec-2022 The monthly target is maintained Comments: IN00978490 ►Number of designated health facilities with COVID-19 case management capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3.00 3.00 3.00 Date 15-May-2020 30-Jun-2020 28-Feb-2021 31-Dec-2022 The monthly target is maintained Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P166013 IDA-64670 Effective USD 15.00 15.00 0.00 3.35 12.26 21% P166013 IDA-67550 Effective USD 2.50 2.50 0.00 0.00 2.79 0% P166013 IDA-D5050 Effective USD 15.00 15.00 0.00 5.64 9.74 37% P166013 IDA-D7030 Effective USD 2.50 2.50 0.00 0.00 2.74 0% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P166013 IDA-64670 Effective 02-Jul-2019 14-Sep-2019 17-Apr-2020 30-Sep-2024 30-Sep-2024 P166013 IDA-67550 Effective 06-Aug-2020 15-Aug-2020 28-Jan-2021 30-Sep-2025 30-Sep-2025 P166013 IDA-D5050 Effective 02-Jul-2019 14-Sep-2019 17-Apr-2020 30-Sep-2024 30-Sep-2024 P166013 IDA-D7030 Effective 06-Aug-2020 15-Aug-2020 28-Jan-2021 30-Sep-2025 30-Sep-2025 Cumulative Disbursements 4/22/2021 Page 8 of 9 The World Bank Implementation Status & Results Report Comprehensive Approach to Health System Strengthening (P166013) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History There has been no restructuring to date. Related Project(s) P174227-Additional Financing Comprehensive Approach to Health System Strengthening 4/22/2021 Page 9 of 9