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): Fatima El Kadiri El Yamani Seq No: 12 | ARCHIVED on 04-May-2021 | ISR43895 | Created by: Miyuki T. Parris on 17-Oct-2020 | Modified by: Fatima El Kadiri El Yamani on 28-Apr-2021 Program Development Objectives PDO Table 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. Board Approved Revised Program Development Objective (If program is formally restructured) The objective of the Program is to expand access to primary health care in targeted rural areas and to strengthen detection and case management to respond to the COVID-19 pandemic in the Program Area. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Implementation Status and Key Decisions Following the declaration of effectiveness of the additional financing on August 14, 2020, significant progress has been made, namely: (a) the target of 629,000 tests was exceeded and verified; (b) guidelines to designate health care facilities as COVID-19 facilities were adopted; and target of health facilities designated and equipped to respond to the COVID-19 pandemic has been surpassed (72 facilities compared to a the target of 50 facilities) and has being verified; and (c) the Program has fully disbursed as of April 20, 2021. Next steps until the Program closing date and an action plan with a timeline to implement delayed environmental and social activities were agreed with the Ministry of Health (MOH) during the March 2021 mission. An implementation completion and results report will be prepared and finalized within 6 months after the closing date. 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 0.00 100.00 0.00 100% P148017 IBRD-91470 Effective USD 35.00 35.00 0.00 35.00 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date 5/4/2021 Page 1 of 13 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) 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 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 2,329,328.00 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 4,682,679.00 Fully Achieved 4,682,679.00 100 % 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 Fully Achieved 290,685.09 100 % 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 5/4/2021 Page 2 of 13 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) 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 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 Fully Achieved 7,019,971.41 100 % HealthCare F for COVID DLR#9.2 Number of 30 Regular USD 6,000,000.00 Fully Achieved 6,000,000.00 100 % HealthCare F for COVID Loan: IBRD91470-001 DLR# 8.1 - 229,000 PCR 8.1 Regular USD 7,812,500.00 Fully Achieved 7,812,500.00 100 % tests conducted DLR# 8.2 - 400,000 PCR 8.2 Regular USD 13,100,000.00 Fully Achieved 13,100,000.00 100 % tests conducted DLR# 9.2 - 50 Health care 9.2 Regular USD 14,000,000.00 Fully Achieved 14,000,000.00 100 % facility 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 5/4/2021 Page 3 of 13 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) 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 Completed Systems 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-2021 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 5/4/2021 Page 4 of 13 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Client Due Date 30-Dec-2016 Completed Completion Measurement Comments Action Description The pilot GRM is evaluated and the implementation manual is reviewed. 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 Completed 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 5/4/2021 Page 5 of 13 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) 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-2021 In Progress Completion Measurement --- 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 Completed 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 Completed 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 5/4/2021 Page 6 of 13 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Moderate Moderate 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 RiskComments Comments While the overall fiduciary risk does not change, the FM risk rating was elevated from Moderate to Substantial for a non-compliance risk due to delays in implementing actions related to the 2019 Audit report recommendations and lack of documentation on previous completed actions. Results PDO Indicators by Objectives / Outcomes The objective of the program is to expand access to primary health care in targeted rural areas IN00905996 ►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 161 829 188 497 189 178 baseline Date 31-Dec-2014 31-Dec-2018 31-Dec-2019 30-Sep-2021 16.9% increase in number of women receiving antenatal care (new cases) during a visit to a rural primary Comments healthcare facility has been achieved IN00905998 ►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 180 812 181 741 181 372 baseline Date 31-Dec-2014 31-Dec-2018 31-Dec-2019 30-Sep-2021 5/4/2021 Page 7 of 13 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Increase of 0.31% in number of deliveries attended by skilled health personnel in public health facilities for Comments women living in rural areas has been achieved IN00906000 ►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 1 078 295 baseline Date 31-Dec-2014 31-Dec-2018 31-Dec-2019 30-Sep-2021 6.4% increase in number of new visits of children under 5 for curative care to a rural primary healthcare Comments facility has been achieved IN00906001 ►Increase in number of patients with diabetes diagnosed and treated at a rural ESSP in the Program Area (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 17.63% increase from Value 136 238 203 948.29 225 474 baseline Date 31-Dec-2014 31-Dec-2018 31-Dec-2019 30-Sep-2021 65.5% increase in number of patients with diabetes diagnosed and treated in rural primary healthcare Comments facilities has been achieved to strengthen detection and case managment to respond to the COVID-19 pandemic IN00905997 ►Number of Polymerase Chain Reaction (PCR) tests conducted to diagnose COVID-19 (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 94.00 2,364,454.00 2,364,454.00 629,000.00 Date 20-Mar-2020 02-Oct-2020 02-Oct-2020 30-Sep-2021 Comments Number of Polymerase Chain Reaction (PCR) tests conducted to diagnose COVID-19 IN00905999 ►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 72.00 72.00 50.00 Date 20-Mar-2020 02-Oct-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 IN00906002 ►Increase in number of visits to rural ESSPs in the Program Area (Text, Custom) 5/4/2021 Page 8 of 13 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) 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-2019 30-Sep-2021 7.9% increase in number of medical consultations (new cases) in rural public primary healthcare facilities Comments has been achieved IN00906005 ►Number of patients with hypertension diagnosed and treated in rural ESSPs (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 180,000.00 273,910.00 312,326.00 287,000.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 30-Sep-2021 Comments IN00906007 ►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 IN00906008 ►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 IN00906009 ►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 5/4/2021 Page 9 of 13 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Comments Establishment of an HMIS in the Program Area IN00906010 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 181,728.00 181,372.00 754,276.00 Date 31-Dec-2014 31-Dec-2017 31-Dec-2019 30-Sep-2021 Comments IN00906011 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 181,741.00 181,372.00 754,276.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2019 30-Sep-2021 Improving health system governance at the primary level IN00906003 ►% 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 IN00906004 ►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 2.00 111.00 15.00 Date 20-Mar-2020 20-Mar-2020 31-Dec-2020 30-Sep-2021 Number of designated laboratories with COVID-19 diagnostic capacities established per MoH guidelines. This number includes private and public sector laboratories. 31 are public and 80 are private Comments sector. IN00906006 5/4/2021 Page 10 of 13 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) ►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 16.9% increase from Value 161,829.00 -- baseline (188 497) baseline (188 497) Date 31-Dec-2014 31-Dec-2018 31-Dec-2019 -- 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, 9864%) Baseline Actual (Previous) Actual (Current) CY2021 0.51% increase from 0.31% increase from Value 180,812.00 -- baseline (181 741) baseline (181 741) Date 31-Dec-2014 31-Dec-2018 31-Dec-2019 -- 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 6.4% increase from Value 1,013,436.00 -- baseline (1 077 022) baseline (1 077 022) Date 31-Dec-2014 31-Dec-2018 31-Dec-2019 -- 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 65.5% increase from Value 136,238.00 -- baseline (203 948) baseline (203 948) 5/4/2021 Page 11 of 13 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Date 31-Dec-2014 31-Dec-2018 31-Dec-2019 -- 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-2019 -- 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%) 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, 100%) Baseline Actual (Previous) Actual (Current) CY2021 Value 94.00 229,000.00 2,433,869.00 629,000.00 Date -- 05-Jun-2020 11-Mar-2021 -- Comments ►DLI 9 Number health care facilities designated COVID-19 facilities and equipped as per MoH guidelines (Outcome, 2.70, 100%) 5/4/2021 Page 12 of 13 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Baseline Actual (Previous) Actual (Current) CY2021 Value 0.00 0.00 72.00 50.00 Date -- 05-Jun-2020 11-Mar-2021 -- Number of health facilities designated COVID-19 facilities and equipped as per MoH guidelines Comments 5/4/2021 Page 13 of 13