The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) MA-Health Sector Support (P148017) MIDDLE EAST AND NORTH AFRICA | Morocco | Health, Nutrition & Population Global Practice | Requesting Unit: MNC01 | Responsible Unit: HMNHN IBRD/IDA | Program-for-Results Financing | FY 2015 | Team Leader(s): Aissatou Diack, Fatima El Kadiri El Yamani Seq No: 11 | ARCHIVED on 16-Oct-2020 | ISR43790 | Created by: Fatima El Kadiri El Yamani on 08-Oct-2020 | Modified by: Fatima El Kadiri El Yamani on 16-Oct-2020 Program Development Objectives Program Development Objective (from Program Appraisal Document) The objective of the Program is to expand access to primary healthcare in targeted rural areas in the Program Area. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Implementation Status and Key Decisions Following the effectiveness of the additional financing on August 14, 2020 and the restructuring which (inter alia) extended the closing date to September 30, 2021, the following progress has been made: (a) the testing targets of 629,000 tests were exceeded (evidence for 229,000 tests has been verified while verification for the remaining 400,000 is currently underway); (b) the ongoing verification of the adoption of guidelines to designate health care facilities as COVID-19 facilities; and (c) targets on health facilities designated and equipped to respond to the COVID-19 pandemic have been surpassed (72 facilities compared to a target of 50 facilities), for which targets are also being verified. A virtual implementation support mission will be scheduled in November 2020 at which time an updated assessment of implementation progress for the remaining Program areas will be carried out, including project activities on primary healthcare, health system governance, and COVID-19 response. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P148017 IBRD-85070 Effective USD 100.00 100.00 0.00 86.69 13.31 87% P148017 IBRD-91470 Effective USD 35.00 35.00 0.00 10.59 24.41 30% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P148017 IBRD-85070 Effective 24-Apr-2015 02-Jul-2015 21-Sep-2015 31-Dec-2019 30-Sep-2021 P148017 IBRD-91470 Effective 16-Jun-2020 03-Jul-2020 14-Aug-2020 30-Sep-2021 30-Sep-2021 10/16/2020 Page 1 of 12 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) DLI Disbursement Achievement Disbursed amount in Disbursement % for DLI ID DLI Type Description Coc DLI Amount Status Coc DLI Loan: IBRD85070-001 DLR#1.1 INCR. IN NO OF Partially 001 Regular USD 2,329,331.00 2,329,328.00 100 % ANTENATAL CARE Achieved DLR#1.2 INCR. IN NO OF 002 Regular USD 2,905,660.00 Fully Achieved 2,905,660.00 100 % ANTENATAL CARE DLR#1.3 INCR. IN NO OF 003 Regular USD 4,082,333.00 Fully Achieved 4,082,333.00 100 % ANTENATAL CARE DLR#1.4 INCR. IN NO OF 004 Regular USD 4,682,676.00 Fully Achieved 4,682,676.00 100 % ANTENATAL CARE DLR#2.1 INCR. IN NO OF Partially 005 Regular USD 776,418.00 776,418.00 100 % DELIVERIES ATTEND Achieved DLR#2.2 INCR. IN NO OF Partially 006 Regular USD 382,343.00 382,343.00 100 % DELIVERIES ATTEND Achieved DLR#2.3 INCR. IN NO OF Partially 007 Regular USD 325,640.50 325,640.50 100 % DELIVERIES ATTEND Achieved DLR#2.4 INCR. IN NO OF 008 Regular USD 290,685.09 Not Achieved 0.00 DELIVERIES ATTEND DLR#3.1 INCR. IN NO OF 009 Regular USD 3,000,000.00 Fully Achieved 3,000,000.00 100 % CURATIVE CARE DLR#3.2 INCR. IN NO OF 010 Regular USD 2,000,000.00 Fully Achieved 2,000,000.00 100 % CURATIVE CARE DLR#3.3 INCR. IN NO OF 011 Regular USD 2,000,000.00 Fully Achieved 2,000,000.00 100 % CURATIVE CARE DLR#3.4 INCR. IN NO OF 012 Regular USD 3,000,000.00 Fully Achieved 3,000,000.00 100 % CURATIVE CARE DLR#4.1 INC. IN NO OF 013 Regular USD 4,639,818.00 Fully Achieved 4,639,818.00 100 % DIABETES PATIENTS DLR#4.2 INC. IN NO OF 014 Regular USD 5,138,968.00 Fully Achieved 5,138,968.00 100 % DIABETES PATIENTS DLR#4.3 INC. IN NO OF 015 Regular USD 5,082,246.00 Fully Achieved 5,082,246.00 100 % DIABETES PATIENTS DLR#4.4 INC. IN NO OF 016 Regular USD 5,138,968.00 Fully Achieved 5,138,968.00 100 % DIABETES PATIENTS DLR#5.1 INC. IN NO OF 017 Regular USD 3,023,257.00 Fully Achieved 3,023,257.00 100 % VISITS TO RURAL ES DLR#5.2 INC. IN NO OF 018 Regular USD 2,325,581.00 Fully Achieved 2,325,581.00 100 % VISITS TO RURAL ES DLR#5.3 INC. IN NO OF 019 Regular USD 2,325,581.00 Fully Achieved 2,325,581.00 100 % VISITS TO RURAL ES DLR#5.4 INC. IN NO OF 020 Regular USD 2,325,581.00 Fully Achieved 2,325,581.00 100 % VISITS TO RURAL ES 10/16/2020 Page 2 of 12 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) DLR#6.1 PCNT OF Partially 021 Regular RURAL HEALTH USD 1,243,652.00 1,243,652.00 100 % Achieved CENTERS DLR#6.2 PCNT OF 022 Regular RURAL HEALTH USD 2,000,000.00 Fully Achieved 2,000,000.00 100 % CENTERS DLR#6.3 PCNT OF 023 Regular RURAL HEALTH USD 2,000,000.00 Fully Achieved 2,000,000.00 100 % CENTERS DLR#6.4 PCNT OF Partially 024 Regular RURAL HEALTH USD 1,961,290.00 1,961,290.00 100 % Achieved CENTERS DLR#7.1 025 Regular ESTABLISHMENT OF USD 5,000,000.00 Fully Achieved 5,000,000.00 100 % HMIS DLR#7.2 026 Regular ESTABLISHMENT OF USD 5,000,000.00 Fully Achieved 5,000,000.00 100 % HMIS DLR#7.3 027 Regular ESTABLISHMENT OF USD 7,000,000.00 Fully Achieved 7,000,000.00 100 % HMIS DLR#7.4 028 Regular ESTABLISHMENT OF USD 6,750,000.00 Fully Achieved 6,750,000.00 100 % HMIS DLR#9.1 Number of 29 Regular USD 7,019,971.41 Not Achieved 0.00 HealthCare F for COVID DLR#9.2 Number of 30 Regular USD 6,000,000.00 Not Achieved 0.00 HealthCare F for COVID Loan: IBRD91470-001 Program Action Plan Finalize the POM by incorporating the new procedures of the National Plan for Medical and Pharmaceutical Waste Action Description Management. Source DLI# Responsibility Timing Timing Value Status Client Due Date 31-May-2016 Completed Completion Measurement Comments The responsible persons in the seven targeted regions will ensure follow up of environmental aspects according to Action Description regulation (decret 2009). Source DLI# Responsibility Timing Timing Value Status Environmental and Social Client Due Date 30-Jun-2020 In Progress Systems 10/16/2020 Page 3 of 12 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Completion Measurement --- Comments The team will follow up on the progress of this action during upcoming mission Creation of a budgetary line in the annual Budgetary of MoH regional directorate and of MoH delegations to Action Description externalize the medical and pharmaceutical waste management at the ESSP levels Source DLI# Responsibility Timing Timing Value Status Client Due Date 30-Mar-2018 Completed Completion Measurement Comments Action Description The seven target regions implement the externalization of the medical and pharmaceutical waste management. Source DLI# Responsibility Timing Timing Value Status Environmental and Social Client Due Date 30-Jun-2020 In Progress Systems Completion Measurement --- Comments The team will follow up on the progress of this action during upcoming mission Action Description The diagnosis of the current GRMs, the strategy and the draft GRM implementation manual are completed. Source DLI# Responsibility Timing Timing Value Status Client Due Date 31-Dec-2015 Completed Completion Measurement Comments Action Description The pilot GRM was completed and the GRM is scaled up is at national level. Source DLI# Responsibility Timing Timing Value Status Client Due Date 30-Dec-2016 Completed Completion Measurement Comments Action Description The pilot GRM is evaluated and the implementation manual is reviewed. 10/16/2020 Page 4 of 12 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Source DLI# Responsibility Timing Timing Value Status Client Due Date 31-Dec-2017 Completed Completion Measurement Comments Action Description The GRM is rolled out at the regional level. Source DLI# Responsibility Timing Timing Value Status Environmental and Social Client Due Date 30-Jun-2020 Completed Systems Completion Measurement --- Comments Audit: Action Description 1) Setting up of internal audit and management control functions at the central and regional levels of the MoH. At the regional levels, these functions will be located within the Regional directorate of Health. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Due Date 30-Jun-2020 In Progress Completion Measurement --- Comments The team will follow up on the progress of this action during upcoming mission Audit: Action Description 2) Agree on improved terms of reference for audit, including procurement and governance. Source DLI# Responsibility Timing Timing Value Status Client Due Date 09-Jun-2017 Completed Completion Measurement Comments Support to the implementation of the new PFM framework and organic finance law. This involves support in the Action Description preparation of a multi-year budget and a draft performance plan, contracting and monitoring and evaluation system. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Due Date 30-Jun-2020 In Progress Completion Measurement --- 10/16/2020 Page 5 of 12 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Comments Update POM to include the new Program area, related activities, indicators, verification protocols, Fiduciary aspects Action Description and ESSA addendum Source DLI# Responsibility Timing Timing Value Status Within 30 days of Technical MoH Other program AF In Progress effectiveness Completion Measurement Updated POM acceptable to the Bank and available for reference Comments Ensure regular monitoring and detail in the annual Program progress report the environmental and social aspects, Action Description that cover inter alia handling of grievances related to the Program, including those related to COVOD-19, and how personal data managemen Source DLI# Responsibility Timing Timing Value Status Environmental and Social Ministry of Health- Due Date 30-Jun-2021 Not Yet Due Systems DPRF Completion Measurement Monitoring reports Comments Development of outreach protocols and mechanisms to ensure the inclusion of vulnerable populations among Action Description program beneficiaries Source DLI# Responsibility Timing Timing Value Status Ongoing/Within 30 Environmental and Social Ministry of Health - Other days of program AF In Progress Systems Div Communication effectiveness Completion Measurement Protocols developed and communications undertaken Comments The team will follow up on the progress of this action during upcoming mission Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Moderate Moderate 10/16/2020 Page 6 of 12 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- Low Low Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and -- Moderate Moderate Sustainability Fiduciary -- Substantial Substantial Environment and Social -- Substantial Substantial Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Moderate Moderate Results PDO Indicators by Objectives / Outcomes The objective of the program is to expand access to primary health care in targeted rural areas IN00902721 ►Increase in number of pregnant women receiving antenatal care during a visit to a rural ESSP in the Program Area (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 5.83% increase from Value 161 829 188 497 188 497 baseline Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2021 Number of women receiving antenatal care (new cases) during a visit to a rural primary healthcare Comments facility/baseline IN00902723 ►Increase in number of deliveries of rural women attended by skilled health personnel in public health facilities in the Program Area (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 0.51% increase from Value 180 812 181 741 181 741 baseline Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2021 Number of deliveries attended by skilled health personnel in public health facilities for women living in rural Comments areas/baseline IN00902725 ►Increase in number of new visits of children under 5 to a rural ESSP in the Program Area for curative care (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 5.00% increase from Value 1 013 436 1 077 022 1 077 022 baseline Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2021 Comments Number of new visits of children under 5 for curative care to a rural primary healthcare facility/baseline IN00902726 ►Increase in number of patients with diabetes diagnosed and treated at a rural ESSP in the Program Area (Text, Custom) 10/16/2020 Page 7 of 12 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Baseline Actual (Previous) Actual (Current) End Target 17.63% increase from Value 136 238 203 948.29 203 948.29 baseline Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2021 Comments Number of patients with diabetes diagnosed and treated in rural primary healthcare facilities/baseline to strengthen detection and case managment to respond to the COVID-19 pandemic IN00902722 ►Number of Polymerase Chain Reaction (PCR) tests conducted to diagnose COVID-19 (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 94.00 229,000.00 2,364,454.00 629,000.00 Date 20-Mar-2020 05-Jun-2020 02-Oct-2020 30-Sep-2021 Comments Number of Polymerase Chain Reaction (PCR) tests conducted to diagnose COVID-19 IN00902724 ►Number health care facilities designated COVID-19 facilities and equipped as per MoH guidelines (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 72.00 50.00 Date 20-Mar-2020 05-Jun-2020 02-Oct-2020 30-Sep-2021 Comments Number health care facilities designated COVID-19 facilities and equipped as per MoH guidelines Intermediate Results Indicators by Results Areas Expanding equitable access to primary care in rural areas IN00902727 ►Increase in number of visits to rural ESSPs in the Program Area (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 4.3% increase from Value 3,794,877 4 098 247 4 098 247 baseline Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2021 Comments Number of medical consultations (new cases) in rural public primary healthcare facilities/baseline IN00902730 ►Number of patients with hypertension diagnosed and treated in rural ESSPs (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 180,000.00 273,910.00 273,910.00 287,000.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 30-Sep-2021 Comments IN00902732 10/16/2020 Page 8 of 12 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) ►Establishment of a comprehensive GRM (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Pilot GRM evaluated Pilot GRM evaluated Roll out of the Value GRM not established Implementation Manual Implementation Manual comprehensive GRM reviewed reviewed Date 31-Dec-2014 29-Dec-2017 29-Dec-2017 30-Sep-2021 Comments IN00902733 ►Definition of an HR incentive mechanism in rural ESSPs (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Implementation mechanism defined, including target diagnostic study diagnostic study indicators, Value Diagnostic not completed completed completed performance criteria, and beneficiaries. Legal documents drafted. Date 31-Dec-2014 31-Dec-2015 31-Dec-2015 30-Sep-2021 Comments Definition of an HR incentive mechanism in rural ESSPs IN00902734 ►Establishment of an HMIS in the Program Area (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target he SMIPF-SC has been The SMIPF-SC has he SMIPF-SC has been operationalized in the been operationalized operationalized in the 100% of public health in the 100% of public Value HMIS not established 100% of public health centers of all the health centers of all centers of all the regions regions within the the regions within the within the Program Area Program Area Program Area Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2021 Comments Establishment of an HMIS in the Program Area IN00902735 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 181,728.00 181,728.00 754,276.00 Date 31-Dec-2014 31-Dec-2017 31-Dec-2017 30-Sep-2021 Comments IN00902736 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 181,741.00 181,741.00 754,276.00 10/16/2020 Page 9 of 12 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2021 Improving health system governance at the primary level IN00902728 ►% of rural health centers with delivery services (CSCAs) in the Program Area that participate in the main biennial quality assessment (concours qualité) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 44% of CSCAs in the Program Area have participated in the main biennial quality assessment (concours Value 13% 43.40 43.40 qualité) and been assessed based on the guide of self-evaluation of rural health centers approved/adopted under DLR#6.3 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 30-Sep-2021 % of rural health centers with delivery services (CSCAs) in the Program Area that participate in the main Comments biennial quality assessment (concours qualité) To strengthen detection and case management to respond to the COVID-19 pandemic IN00902729 ►Number of designated laboratories with COVID-19 diagnostic capacities established per MoH guidelines (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 2.00 2.00 15.00 Date 20-Mar-2020 20-Mar-2020 20-Mar-2020 30-Sep-2021 Comments Number of designated laboratories with COVID-19 diagnostic capacities established per MoH guidelines IN00902731 ►Number of resuscitation units established as per MoH guidelines (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 55.00 Date 20-Mar-2020 20-Mar-2020 20-Mar-2020 30-Sep-2021 Comments Number of ICU units as per MoH guidelines Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 Increase in number of pregnant women receiving antenatal care during a visit to a rural ESSP in the Program Area (Output, 14,000,000.00, 100%) Baseline Actual (Previous) Actual (Current) CY2021 16.5% increase from 16.5% increase from Value 161,829.00 -- baseline (188 497) baseline (188 497) 10/16/2020 Page 10 of 12 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 -- Comments ►DLI 2 Increase in number of deliveries of rural women attended by skilled health personnel in public health facilities in the Program Area (Output, 1,775,086.59, 84%) Baseline Actual (Previous) Actual (Current) CY2021 0.51% increase from 0.51% increase from Value 180,812.00 -- baseline (181 741) baseline (181 741) Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 -- Comments ►DLI 3 Increase in number of new visits of children under 5 to a rural ESSP in the Program Area for curative care (Output, 10,000,000.00, 100%) Baseline Actual (Previous) Actual (Current) CY2021 6.27% increase from 6.27% increase from Value 1,013,436.00 -- baseline (1 077 022) baseline (1 077 022) Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 -- Comments ►DLI 4 Increase in number of patients with diabetes diagnosed and treated at a rural ESSP in the Program Area (Output, 20,000,000.00, 100%) Baseline Actual (Previous) Actual (Current) CY2021 49.7% increase from 49.7% increase from Value 136,238.00 -- baseline (203 948) baseline (203 948) Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 -- Comments ►DLI 5 Increase in number of visits to rural ESSPs in the Program Area (Output, 10,000,000.00, 100%) Baseline Actual (Previous) Actual (Current) CY2021 7.9% increase from 7.9% increase from Value 3,794,877 -- baseline (4 098 247) baseline (4 098 247) Date -- 31-Dec-2018 31-Dec-2018 -- Comments ►DLI 6 % of rural health centers with delivery services (CSCAs) in the Program Area that participate in the main biennial quality assessment (concours qualité) (Output, 7,204,942.00, 17%) 10/16/2020 Page 11 of 12 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Baseline Actual (Previous) Actual (Current) CY2021 Value 13% 43.4% 43.4% -- Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 -- Comments ►DLI 7 Establishment of an HMIS in the Program Area (Output, 23,750,000.00, 42%) Baseline Actual (Previous) Actual (Current) CY2021 The SMIPF-SC has been The SMIPF-SC has been operationalized in the operationalized in the Value Not established 100% of public health 100% of public health -- centers of all the regions centers of all the regions within the Program Area within the Program Area Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 -- Comments ►DLI 8 Number of Polymerase Chain Reaction (PCR) tests conducted to diagnose COVID-19 (Outcome, 20,912,500.00, 0%) Baseline Actual (Previous) Actual (Current) CY2021 Value 94.00 229,000.00 229,000.00 629,000.00 Date -- 05-Jun-2020 05-Jun-2020 -- Comments ►DLI 9 Number health care facilities designated COVID-19 facilities and equipped as per MoH guidelines (Outcome, 2.70, 0%) Baseline Actual (Previous) Actual (Current) CY2021 Value 0.00 0.00 0.00 50.00 Date -- 05-Jun-2020 05-Jun-2020 -- Number of health facilities designated COVID-19 facilities and equipped as per MoH guidelines Comments 10/16/2020 Page 12 of 12