The World Bank Report No: ISR8167 Implementation Status & Results India India: Karnataka Health Systems (P071160) Public Disclosure Copy Operation Name: India: Karnataka Health Systems (P071160) Project Stage: Implementation Seq.No: 12 Status: ARCHIVED Archive Date: 14-Dec-2012 Country: India Approval FY: 2007 Product Line: IBRD/IDA Region: SOUTH ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Government of Karnataka Department of Health Key Dates Board Approval Date 22-Aug-2006 Original Closing Date 31-Mar-2012 Planned Mid Term Review Date 01-Dec-2008 Last Archived ISR Date 05-Jun-2012 Effectiveness Date 11-Jan-2007 Revised Closing Date 31-Mar-2016 Actual Mid Term Review Date 16-Jul-2010 Project Development Objectives Project Development Objective (from Project Appraisal Document) To improve health service delivery, public-private collaboration, and financing, particularly for the benefit of underserved and vulnerable groups in Karnataka. Has the Project Development Objective been changed since Board Approval of the Project? � Yes No Component(s) Component Name Component Cost Component I: Strengthening existing government health programs towards the achievement of more 115.07 effective and equitable delivery of s Component II: Innovations in service delivery and health financing 110.00 Component III: Project Management, Monitoring and Evaluation 15.16 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Implementation Status Overview During five years of implementation to date, the project has substantially contributed to development of the health sector in the state, including support to development of district administrative capacity and planning, health service standards and guidelines, health financing analysis, procurement reform, and monitoring and evaluation. The project has also supported training and organizational development to improve government's capacity to manage the sector as well as capital investment in health service delivery capacity with a focus on maternal health services. In addition, the project has supported substantial engagement with the private sector, including contracts with NGOs to operate mobile health clinics, hospital help desks, and diagnostic laboratories, as well as implement community-level public health interventions. The project also supported a state government scheme that Page 1 of 5 The World Bank Report No: ISR8167 purchases hospital services for poor beneficiaries from accredited public and private hospitals. Project indicators have shown significant progress: the proportion of births delivered in a health facility has risen from 65% in 2005-06 to 86% in 2009 (against a target of 90%); the proportion of children fully immunized has increased from 55% in 2005-06 to 78% in 2009 (against a target of 80%); 96 mobile health clinics are operational (against a target of 97); and the number of claims paid by a health insurance pilot program benefiting poor households is 19,199 (far exceeding the target of 7,500). Public Disclosure Copy At the government's request, additional financing of US$ 70 million was approved by the International Development Association (IDA) Board in September 2012 and the project closing date was extended to March 2016. Additional government co-financing will be US$ 35 million. These additional funds will allow continued support and strengthening of organizational development and quality assurance activities, investment in maternal and primary health care services, public-private contracting, environmental health and regulation, and the program that finances hospital care for the poor. New activities will include interventions in the areas of non-communicable disease prevention and control as well as road safety and emergency health services. Locations Country First Administrative Division Location Planned Actual India State of Karnataka State of Karnataka Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percent of births/deliveries occuring in a health Percentage Value 65.00 86.00 90.00 facility Date 31-Mar-2006 31-Mar-2009 31-Mar-2016 Comments NFHS III (2005-06) UNICEF Coverage Evaluation planned DLHS IV Survey, 2009 Percent of birth/deliveries occuring in a health Percentage Value 37.00 45.00 55.00 facility among the poor Date 31-Mar-2004 31-Mar-2008 31-Mar-2016 Comments DLHS II (2002-04) DLHS III (2007-08) planned DLHS IV Percent of population receiving outpatient care Percentage Value 46.00 75.00 78.00 in government facilities in 7 less-developed Date 31-Mar-2006 31-Mar-2012 31-Mar-2016 districts Comments HMIS HMIS HMIS Public Disclosure Copy Number of health claims paid by health Number Value 0.00 19199.00 45000.00 insurance pilot program benefitting Below Date 31-Mar-2006 31-Mar-2012 31-Mar-2016 Poverty Line (BPL) households Comments Number of women screened for cervical cancer Number Value 0.00 0.00 60000.00 in pilot districts Date 31-Mar-2006 31-Mar-2012 31-Mar-2016 Comments Not Applicable Screening not initiated Page 2 of 5 The World Bank Report No: ISR8167 Percent change in number of road traffic Percentage Value 0.00 0.00 10.00 accident patients transported by 108 Date 31-Mar-2006 31-Mar-2012 31-Mar-2016 ambulance system who receive emergency Comments Not Available care at government health facilities in pilot Public Disclosure Copy districts Direct project beneficiaries Number Value 0.00 167000000.00 306000000.00 Date 31-Mar-2006 31-Mar-2012 31-Mar-2016 Comments Female beneficiaries Percentage Value 0.00 50.00 50.00 Sub Type Supplemental Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Health personnel receiving training (number) Number Value 0.00 385.00 25500.00 Date 22-Aug-2006 31-Mar-2012 31-Mar-2016 Comments Births (deliveries) attended by skilled health Number Value 0.00 3400000.00 5200000.00 personnel (number) Date 31-Mar-2005 31-Mar-2012 31-Mar-2016 Comments Health facilities constructed, renovated, and/or Number Value 0.00 275.00 375.00 equipped (number) Date 31-Mar-2006 31-Mar-2012 31-Mar-2016 Comments Number of mobile health clinics operational Number Value 0.00 96.00 125.00 Date 31-Mar-2006 31-Mar-2012 31-Mar-2016 Comments Percent of government Primary Health Centers Percentage Value 0.00 42.00 47.00 Public Disclosure Copy (PHCs) providing round-the-clock services Date 31-Mar-2006 31-Mar-2012 31-Mar-2016 Comments Training materials on non-communicable Yes/No Value No No Yes disease activities for clinical staff are developed Date 31-Mar-2006 31-Mar-2012 31-Mar-2016 Comments Not Available Guidelines and standards for trauma care Yes/No Value No No Yes services are developed Date 31-Mar-2006 31-Mar-2012 31-Mar-2016 Comments Not Available Page 3 of 5 The World Bank Report No: ISR8167 Information and communication technology Yes/No Value No No Yes (ICT) pilot starts implementation Date 31-Mar-2006 31-Mar-2012 31-Mar-2016 Comments Not Available Public Disclosure Copy Data on Financial Performance (as of 13-Nov-2012) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P071160 IDA-42290 Effective 22-Aug-2006 16-Oct-2006 11-Jan-2007 31-Mar-2012 31-Mar-2013 P071160 IDA-51610 Not Effective 27-Sep-2012 31-Mar-2016 31-Mar-2016 P071160 TF-99435 Effective 07-Oct-2011 14-Oct-2011 14-Oct-2011 31-Aug-2013 31-Aug-2013 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P071160 IDA-42290 Effective USD 141.83 141.83 0.00 122.37 26.77 86.00 P071160 IDA-51610 Not Effective USD 70.00 70.00 0.00 0.00 71.60 0.00 P071160 TF-99435 Effective USD 0.40 0.40 0.00 0.00 0.40 0.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation Page 4 of 5 The World Bank Report No: ISR8167 No decisions for disclosure Restructuring History Public Disclosure Copy Level two Approved on 08-Dec-2010, Level two Approved on 28-Feb-2012, Level two Approved on 07-Aug-2012 Related Projects P126846-India: Karnataka Health - Additional Financing, P130395-India: Karnataka Health Systems Additional Financing Public Disclosure Copy Page 5 of 5