The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) Andhra Pradesh Health Systems Strengthening Project (P167581) SOUTH ASIA | India | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2019 | Seq No: 4 | ARCHIVED on 12-Jan-2021 | ISR44542 | Implementing Agencies: Republic of India, Department of Health, Medical and Family Welfare, Govt. of Andhra Pradesh Key Dates Key Project Dates Bank Approval Date: 15-May-2019 Effectiveness Date: 09-Sep-2019 Planned Mid Term Review Date: 30-Apr-2022 Actual Mid-Term Review Date: Original Closing Date: 30-Sep-2024 Revised Closing Date: 30-Sep-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objectives are to improve the quality and responsiveness of public health services and increase access of the population to an expanded package of primary health services. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Improve Quality of Care:(Cost $1298.12 M) Improve Responsiveness of Public Health Services:(Cost $157.23 M) Increase Access to an Expanded Package of Primary Health Services:(Cost $1867.88 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions The progress of the Project towards the achievement of its Project Development Objective (PDO) continues to be satisfactory. While implementation progress had slowed down due to COVID-19, a resumption of project activities is seen which is expected to contribute to the achievement of key results in the coming six months. Since the previous review, the State has continued actions to improve quality of care with the development of a quality tracking dashboard which is currently under testing; an additional 13 CHCs providing an enhanced package of services, which includes radiology (X-ray), laboratory diagnostics and CEmONC services; and about 88 percent CHCs achieving at least 90 percent sanitation score monthly during the period July to November 2020. Actions to roll out an integrated online patient management system, including personal electronic health records that would allow for better management of patients over time and through the public health system, and a system to record patient experience have been initiated. Initiatives such as the development of an application to support registry, screening, risk-stratification, management and follow up of non-communicable 1/12/2021 Page 1 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) disease patients has also started and is expected to be rolled out early next year. This is expected to provide an impetus to non-communicable disease service provision at the primary care level. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Moderate Moderate Macroeconomic Low Low Low Sector Strategies and Policies Low Low Low Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Low Low Low Sustainability Fiduciary Moderate Moderate Moderate Environment and Social Moderate Moderate Moderate Stakeholders Low Low Low Other -- -- -- Overall Moderate Moderate Moderate Results PDO Indicators by Objectives / Outcomes Improve quality of care IN00925080 ►Increase in number of CHCs and PHCs with quality certification (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 46.00 46.00 198.00 Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 While 28 facilities (11 CHCs and 17 PHCs) have received full NQAS certification, 18 received partial Comments: certification (9 CHCs and 9 PHCs). Improve responsiveness of public health services IN00925079 1/12/2021 Page 2 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) ►Increase in the average patient reported experience score (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Baseline to be Baseline to be Baseline to be 5 percentage point Value established for patient established for patient established for patient increase from baseline reported experience reported experience reported experience Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 Development of system to measure patient experience in process. Comments: Increase acess to an expanded package of primary health services IN00925216 ►Increase in percentage of patients diagnosed and at risk of hypertension and diabetes, managed as per protocol at the SC or PHC (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Clinical protocols for NCD screening and Baseline to be Baseline to be risk stratification Increase in baseline established following established following Value defined. Baseline to be value by 2 percentage development of clinical development of clinical established once NCD point protocols protocols system is installed at PHC and CHCs Date 01-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 Development of system to track patient management in process. Protocols have been issued. Comments: IN00925217 ►Increase in the number of districts with at least 90% of pregnant women receiving full ante-natal care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 7.00 7.00 11.00 Date 28-Feb-2019 31-Dec-2019 30-Nov-2020 30-Jun-2024 7 districts achieved the result based on data for the calendar year 2019. Achievement for calendar year Comments: 2020 will be due in January 2021. Intermediate Results Indicators by Components Improve Quality of Care IN00925218 ►Increase in the number of CHCs and PHCs with more than 70 percent quality accreditation score following the State-level internal assessment (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 120.00 120.00 390.00 Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 Comments: 120, includes 40 CHCs and 80 PHCs 1/12/2021 Page 3 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) IN00925221 ►Establish and operate a quality tracking dashboard covering PHC and CHC facilities for supporting quality improvement and maintenance (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 100 PHC and CHC No dashboard currently No dashboard currently No dashboard facilities included in Value exists exists currently exists quarterly dashboard reports Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 The Quality Tracking Dashboard is developed and is under testing. Will be fully rolled out by January Comments: 2021. IN00925223 ►Increase in the number of CHCs covered by a core package of services contributing towards quality of care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.00 28.00 65.00 Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 IN00925225 ►Increase in the percentage of CHCs achieving at least 90% sanitation score monthly for a period of at least six months in a year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 92.70 98.00 90.00 Date 28-Feb-2019 31-Dec-2019 30-Nov-2020 30-Jun-2024 Overall, 98% CHCs (192 out of a total 195 CHCs) achieved at least 90% monthly sanitation score for a period of at least 6 months in the calendar year period January to November 2020. The breakdown by six monthly period is as follows: -- 168 CHCs out of total 195 CHCs (86%) achieved at least 90% monthly sanitation score for a period of at least 6 months - from the period January to June 2020. Comments: -- 173 CHCs out of total 195 CHCs (88%) achieved at least 90% monthly sanitation score for a period of 5 months - from the period July to November 2020. IN00925228 ►Improvement in the pharmaceutical stock management system at the PHCs and CHCs (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Existing system Existing system provides Existing system provides provides information information on current information on current on current stock, but Quarterly stock- status stock, but has limited stock, but has limited Value has limited advanced reports for PHCs and advanced functions such advanced functions such functions such as auto CHCs generated as auto alerts indicating as auto alerts indicating alerts indicating low low stock low stock stock Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 1/12/2021 Page 4 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) Discussions on system upgrades ongoing. Comments: IN00925231 ►Establish a system for routine maintenance and repair for bio-medical equipment at the CHC level (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Functional System in Value No system in place No system in place No system in place place Date 30-Jun-2019 30-Jun-2020 30-Nov-2020 30-Jun-2022 Finalization of terms of reference for service contract for bi-medical equipment maintenance in process. Comments: Improve Responsiveness of Public Health Services IN00925219 ►Increase in the number of health facilities with an operational integrated online patient management system (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1,400.00 Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 IN00925222 ►Increase in the percentage of patients accessing their individual EMR (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 6% increase from Value 0.00 0.00 0.00 baseline Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 IN00925226 ►Increase in the number of facilities where the system for measuring and reporting on patient experience is operational (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1,400.00 Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 IN00925229 ►Percentage of districts organizing quarterly review meetings on patient feedback (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 Increase Access to an Expanded Package of Primary Health Services IN00925220 1/12/2021 Page 5 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) ►Increase in the number of functional health and wellness centres (HWCs) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 3,000.00 Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 IN00925224 ►Increase in the number of subcenters with trained mid-level service providers (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 300.00 1,100.00 1,123.00 5,900.00 Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 An additional 948 recruits are currently under training as MLSPs. Recruitment of additional MLSPs will be Comments: proposed in the NHM PIP for FY21-22 IN00925227 ►Increase in the percent of adult population screened and stratified by risk as per clinical protocols for hypertension and diabetes (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 12.00 12.00 12.00 67.00 Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 Information System to enable screening and risk stratification is under development Comments: IN00925230 Increase in the percent of male population screened and stratified by risk as per clinical protocols for hypertension and diabetes (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.00 1.00 35.00 Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 IN00925232 Increase in the percent of female population screened and stratified by risk as per clinical protocols for hypertension and diabetes (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 23.00 23.00 23.00 70.00 Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 IN00925233 ►Increase in the percentage of women above age 30 years screened for cervical cancer at subcenters or PHC facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 26.00 26.00 26.00 70.00 1/12/2021 Page 6 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2024 Information System to enable screening and risk stratification is under development. Comments: IN00925234 ►Research and evaluation undertaken to support the innovative approaches to delivery of primary health care (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Population-based survey Population-based survey Population-based of NCD risk factor of NCD risk factor survey of NCD risk prevalence not prevalence not factor prevalence not End-line study for Value undertaken and e- undertaken and e- undertaken and e- evaluation on e- subcenter model overall subcenter model overall subcenter model subcenter completed effectiveness not effectiveness not overall effectiveness evaluated evaluated not evaluated Date 28-Feb-2019 30-Jun-2020 30-Nov-2020 30-Jun-2023 RFP to engage firm to undertake HWC evaluation issued and MoU for STEP survey expected to be Comments: signed in December 2020 and survey to start in January 2021. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P167581 IBRD-89450 Effective USD 328.00 328.00 0.00 46.01 281.99 14% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P167581 IBRD-89450 Effective 15-May-2019 27-Jun-2019 09-Sep-2019 30-Sep-2024 30-Sep-2024 Cumulative Disbursements 1/12/2021 Page 7 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) 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 20-Apr-2020 Related Project(s) There are no related projects. 1/12/2021 Page 8 of 8