The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Transforming Egypt's Healthcare System Project (P167000) MIDDLE EAST AND NORTH AFRICA | Egypt, Arab Republic of | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2018 | Seq No: 5 | ARCHIVED on 28-Oct-2020 | ISR42321 | Implementing Agencies: Ministry of Investment and International Cooperation, Ministry of Health and Population Key Dates Key Project Dates Bank Approval Date: 27-Jun-2018 Effectiveness Date: 07-Sep-2018 Planned Mid Term Review Date: 14-Jan-2021 Actual Mid-Term Review Date: Original Closing Date: 31-Dec-2023 Revised Closing Date: 31-Dec-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed Project Development Objective is to (i) improve the quality of primary and secondary health care services, (ii) enhance demand for health and family planning services, and (iii) support the prevention and control of Hepatitis C. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Strengthen Primary Healthcare, Family Planning and Community Activities:(Cost $247.40 M) Strengthen Secondary Level Healthcare:(Cost $274.60 M) Institutional Capacity Building and Project Management:(Cost $8.00 M) Contingency Emergency and Response Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions This is the fifth ISR for the project, which was approved by the World Bank Board of Executive Directors on June 27, 2018, with the Loan Agreement signed on July 10, 2018. The project was declared effective on September 7, 2018, well ahead of the envisioned Effectiveness date at project design. Project Implementation: The project is making good progress. Overall progress towards achievement of the Project Development Objective is rated as Satisfactory, and Implementation Progress is rated Moderately Satisfactory. The disbursement rate is well ahead of schedule at 53% and a functioning Project Management Unit is in place. The screening of Hep C and NCDs has exceeded its targets and been completed two years earlier than planned. The Project Operations Manual has been finalized, the GRM manual has been updated and staff trained on the GRM. Major procurement of activities is well underway, with others being finalized. 10/28/2020 Page 1 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Substantial Substantial Moderate Institutional Capacity for Implementation and Moderate Moderate Moderate Sustainability Fiduciary High High High Environment and Social Moderate Moderate Moderate Stakeholders Substantial Substantial Substantial Other -- -- High Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improve the quality of primary health care services IN00858299 ►Number of PHCs passing Quality Services Index composite indicators list (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 600.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 The QSI manual and action plan for targeted PHCs staff training is completed and 130 PHCs are being Comments: monitored for phase one to be verified by the end of 2020. IN00858328 ►Percentage improvement in the average quality of clinical care score at all targeted PHCs, measured through independent direct observations (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 54.96 54.96 80.00 10/28/2020 Page 2 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 The average total quality score percent in all 8 Governorates is 54.96%. The highest score was in Comments: Elbeheira with 78.2% and the lowest was in South Sinai with 41.0%. The year 2 target has been met. Improve the quality of secondary health care services IN00858327 ►Percentage improvement in the average quality of clinical care score at all targeted hospitals measured through independent direct observations (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 66.00 66.00 80.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 The total average quality of clinical care score in the four hospitals is 66%, with the highest score in the Aswan Specialized hospital with 78.24% and the lowest in the Alagamy Central hospital with 57.5%. The Comments: year 2 target is met. IN00858329 ►Percentage of blood units dispensed at MOHP affiliated hospitals that have been screened utilizing the Nucleic Acid test (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 90.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 Procurement of activities has started but not yet resulted in achievement of the target. Comments: Enhance Demand for Health and Family Planning Services IN00858326 ►Contraceptive prevalence rate (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 58.00 58.00 58.00 65.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 Data for this indicator is not required until year 3. Comments: Prevention and control of Hepatitis C IN00858300 ►Number of people screened for Viral Hepatitis C (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 49,931,654.00 49,931,654.00 35,000,000.00 Date 02-Jul-2018 15-Aug-2019 17-Aug-2020 31-Dec-2023 10/28/2020 Page 3 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) The end target for the screen of Hepatitis C has been met (and exceeded) 3 years earlier than planned. Comments: IN00858330 Percent Female (Percentage, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 52.00 52.00 50.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 29-Dec-2023 IN00858331 ►Percentage of people who received treatment for Hepatitis C who have taken the final confirmation test for sustained virological response (SVR) using a random sampling methodology (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 79.00 79.00 80.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 While the end target was met in the September 2019 ISR, the results is now slightly lower than the target at 72.8% (actual), with a target of 80%. This exceeds the target for this stage of project implementation Comments: (year 3 = 70%). The Ministry of Health and Population is actively working to ensure that patients who tested positive for Hep C receive the full treatment and final confirmatory test. Intermediate Results Indicators by Components Strenghten Primary Healthcare, Family Planning and Community Activities IN00858332 ►PHC mapping exercise, needs assessments and new accreditation tool completed. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 4.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 The PHC needs assessments have been completed and the mapping exercises are underway. Comments: IN00858335 ►Increased household visits by CHWs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7.00 7.00 21.70 32.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 This indicator is measured yearly. Activities related to CHWs is on-going. Comments: IN00858337 ►Percentage of participating districts certified for enhanced governance performance (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 10/28/2020 Page 4 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Value 0.00 21.30 21.30 100.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 The curriculum for financial training (65 districts) has been completed, as has the action plan for the Comments: training. Year 2 training is on-going, to be assessed by the end of the year. IN00858339 ►Client user satisfaction and utilization surveys conducted in project target areas (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 5.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 IN00858341 ►Grievances addressed in project target facilities using the GRM in accordance with the revised manual issued in 2017 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 The GRM manual has been completed and printed and training on the GRM delivered. Comments: IN00858343 ►Average patient satisfaction level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 66.50 66.50 65.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 A pilot study for the patient satisfaction tool was conducted. The average total patient satisfaction percent score in all pilot PHCs was 66.5% (exceeding the end target), with the highest score sin Aswan, Elbeheira Comments: and Matrouh with 70% and the lowest in Alexandria with 50%. IN00858344 ►Targeted people screened for NCDs (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 49,931,654.00 49,931,654.00 20,000,000.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 The end target has been met (and exceeded) 3 years ahead of schedule. Comments: IN00858345 Percent Female (Percentage, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 52.00 52.00 50.00 10/28/2020 Page 5 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 29-Dec-2023 IN00858346 ►Targeted PHCs applying environmentally-positive energy and water efficiency measures (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 600.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 The Needs Assessment for energy saving lamps, has been completed for 113 PHCs. Comments: IN00858347 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,350,411.00 2,067,737.00 3,400,000.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 Services delivered until December 2019 Comments: IN00858348 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,350,911.00 2,067,737.00 3,400,000.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 Strengthen Secondary Level Healthcare IN00858334 ►Targeted regional blood banks that have been connected to the national automated blood network. (Amount(USD), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 11.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 IN00858336 ►Targeted Hep C patients treated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,056,274.00 1,073,586.00 1,500,000.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 The year 4 target has been met, 3 years early. Comments: IN00858338 Percent Female (Percentage, Corporate Breakdown) 10/28/2020 Page 6 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 56.00 45.00 40.00 Date 20-Jun-2018 02-Mar-2020 17-Aug-2020 29-Dec-2023 IN00858340 ►Number of PHCs receiving National Accreditation Certification for healthcare quality (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 600.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 The tool for accreditation has not yet been published. It is the responsibility of the new Organization Comments: of Accreditation and Monitoring. IN00858342 ►Number of Hospitals receiving National Accreditation Certification for healthcare quality in target governorates (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 27.00 Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 The tool for accreditation has not yet been published. It is the responsibility of the new Organization Comments: of Accreditation and Monitoring. Institutional Capacity Building ad Project Management IN00858333 ►Project results published regularly on external MOHP website (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 Yes Yes Yes Date 02-Jul-2018 02-Mar-2020 17-Aug-2020 31-Dec-2023 End target achieved. Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed 10/28/2020 Page 7 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) P167000 IBRD-88950 Effective USD 530.00 530.00 0.00 282.26 247.74 53% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P167000 IBRD-88950 Effective 27-Jun-2018 10-Jul-2018 07-Sep-2018 31-Dec-2023 31-Dec-2023 Cumulative Disbursements 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) There are no related projects. 10/28/2020 Page 8 of 8