Public Disclosure Copy The World Bank Implementation Status & Results Report Karnataka Health System Development and Reform Project (P071160) Karnataka Health System Development and Reform Project (P071160) SOUTH ASIA | India | Health, Nutrition & Population Global Practice | IBRD/IDA | Specific Investment Loan | FY 2007 | Seq No: 19 | ARCHIVED on 03-Feb-2016 | ISR20704 | Implementing Agencies: KHSDRP Key Dates Key Project Dates Bank Approval Date:22-Aug-2006 Effectiveness Date:11-Jan-2007 Planned Mid Term Review Date:01-Dec-2008 Actual Mid-Term Review Date:16-Jul-2010 Original Closing Date:31-Mar-2012 Revised Closing Date:31-Mar-2016 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 andvulnerable groups in Karnataka. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Component 1. Strengthening existing government health programs:(Cost $75.30 M) Component 2. Innovations in service delivery and health financing:(Cost $115.80 M) Component 3. Project Management, Monitoring and Evaluation:(Cost $20.70 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Satisfactory Overall Risk Rating  Moderate  Moderate 2/3/2016 Page 1 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Karnataka Health System Development and Reform Project (P071160) Implementation Status and Key Decisions The Karnataka Health Systems Development and Reform Project continues on track to achieving its development objectives. The Project Development Objective (PDO) and Intermediate outcome indicators in the results framework have shown steady improvement. Five of the eight PDO indicators and Six of the 9 Intermediate outcome indicators have achieved or surpassed end-of-project targets. The activities agreed during the previous mission (January 20-23, 2015) in the areas of non-communicable disease (NCD) prevention and control, emergency health services/road safety, quality assurance (QA), health insurance, investment in maternal and primary health services are on track. All of the technical work and most of the procurement required for the NCD, emergency health services/road safety, and quality assurance activities, has been completed. Most of the civil works under the original credit have been concluded and the works under the additional financing are in progress and scheduled to be completed by the end of the project. The health insurance scheme implemented by SAST that finances tertiary hospital care services for the poor continues to show substantial results. All disbursement milestones of the original credit and three of the four milestones from the additional financing have been achieved by the program. Progress has also been made towards completion of the remaining milestone. Progress is mixed for public-private contracting and very little progress was achieved under organizational development (OD). An assessment of the OD component will be made in November to determine the likelihood that activities will be completed by the end of the project. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  Low  Low Macroeconomic  --  Moderate  Moderate Sector Strategies and Policies  --  Low  Low Technical Design of Project or Program  --  Low  Low Institutional Capacity for Implementation and Sustainability  --  Moderate  Moderate Fiduciary  --  Moderate  Moderate Environment and Social  --  Low  Low Stakeholders  --  Low  Low Other  --  --  -- Overall  --  Moderate  Moderate Results Project Development Objective Indicators PHINDPDOTBL  Direct project beneficiaries (Number, Core) 2/3/2016 Page 2 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Karnataka Health System Development and Reform Project (P071160) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 327000000.00 361381915.00 306000000.00 Date 31-Mar-2006 31-Dec-2014 30-Jun-2015 31-Mar-2016 PHINDPDOTBL  Female beneficiaries (Percentage, Core Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 52.00 50.00 PHINDPDOTBL  Percent of births/deliveries occuring in a health facility (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.00 99.00 89.00 90.00 Date 31-Mar-2006 31-Mar-2015 30-Jun-2015 31-Mar-2016 Comments The source of the Data is District Level Household and Facility Survey (DLHS-4) with data indicators for Year 2012-13; Published on Data Portal Wednesday, December 24, 2014 - 12:56 PHINDPDOTBL  Percent of birth/deliveries occuring in a health facility among the poor (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 37.00 45.00 45.00 55.00 Date 31-Mar-2004 31-Mar-2008 31-Mar-2008 31-Mar-2016 Comments The project will request for data from program team and DLHS implementation agency. 2/3/2016 Page 3 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Karnataka Health System Development and Reform Project (P071160) PHINDPDOTBL  Percent of population receiving outpatient care in government facilities in 7 less-developed districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 46.00 92.00 90.26 78.00 Date 31-Mar-2006 31-Dec-2013 30-Jun-2015 31-Mar-2016 Comments Data recorded from Apr 2014- March 2015. PHINDPDOTBL  Number of health claims paid by health insurance pilot program benefitting Below Poverty Line (BPL) households (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 92112.00 112090.00 120000.00 Date 31-Mar-2006 31-Jan-2015 30-Jun-2015 31-Mar-2016 PHINDPDOTBL  Number of women screened for cervical cancer in pilot districts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 293.00 1000.00 Date 31-Mar-2006 23-Jan-2015 30-Jun-2015 31-Mar-2016 Comments Screening Data reported from the Dakshin Kannada district. Screening has started in Davangere but the data was not yet available at the time of the mission. PHINDPDOTBL  percent change in number of road traffic accident patients transported by government ambulance system (108 system) in pilot districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 13.00 39.00 10.00 Date 31-Mar-2006 31-Dec-2014 31-Mar-2015 31-Mar-2016 2/3/2016 Page 4 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Karnataka Health System Development and Reform Project (P071160) Comments Total 12,223 number of road traffic accident patients transported by government ambulance system in pilot districts; namely Bagalkot, Belgaum and Mandya between April 2014-March 2015. Overall Comments Intermediate Results Indicators PHINDIRITBL  Health personnel receiving training (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 42772.00 51458.00 25500.00 Date 22-Aug-2006 31-Mar-2015 30-Jun-2015 31-Mar-2016 PHINDIRITBL  Births (deliveries) attended by skilled health personnel (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5100000.00 5366869.00 5200000.00 Date 31-Mar-2005 31-Mar-2015 30-Jun-2015 31-Mar-2016 PHINDIRITBL  Health facilities constructed, renovated, and/or equipped (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 341.00 345.00 375.00 Date 31-Mar-2006 31-Mar-2015 30-Jun-2015 31-Mar-2016 2/3/2016 Page 5 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Karnataka Health System Development and Reform Project (P071160) PHINDIRITBL  Percent of government Primary Health Centers (PHCs) providing round-the-clock services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 47.61 47.61 47.00 Date 31-Mar-2006 31-Mar-2015 30-Jun-2015 31-Mar-2016 PHINDIRITBL  Training materials on non-communicable disease activities for clinical staff are developed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 31-Mar-2006 31-Mar-2015 30-Jun-2015 31-Mar-2016 PHINDIRITBL  Guidelines and standards for trauma care services are developed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date -- 31-Mar-2015 30-Jun-2015 31-Mar-2016 PHINDIRITBL  number of claims paid to private sector hospitals by the government health insurance program supported by the project (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 60000.00 89000.00 90000.00 Date 31-Jan-2015 31-Jan-2015 30-Jun-2015 31-Mar-2016 2/3/2016 Page 6 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Karnataka Health System Development and Reform Project (P071160) PHINDIRITBL  number of private hospitals empaneled by SAST that have submitted at least 100 claims (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 45.00 92.00 50.00 Date 31-Mar-2006 31-Jan-2015 30-Jun-2015 31-Mar-2016 PHINDIRITBL  number of hospitals empaneled to provide care to road accident victims under the government program (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 31-Jan-2015 31-Jan-2015 31-Jan-2015 31-Mar-2016 Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P071160 IDA-42290 Effective USD 141.83 141.83 0.00 146.19 2.27 103% P071160 IDA-51610 Effective USD 70.00 70.00 0.00 33.84 31.70 48% P071160 TF-99435 Closed USD 0.40 0.22 0.18 0.22 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P071160 IDA-42290 Effective 22-Aug-2006 16-Oct-2006 11-Jan-2007 31-Mar-2012 31-Mar-2016 P071160 IDA-51610 Effective 27-Sep-2012 21-Nov-2012 22-Jan-2013 31-Mar-2016 31-Mar-2016 P071160 TF-99435 Closed 07-Oct-2011 14-Oct-2011 14-Oct-2011 31-Aug-2013 31-Aug-2014 Cumulative Disbursements 2/3/2016 Page 7 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Karnataka Health System Development and Reform Project (P071160) Restructuring History Level Approved on 08-Dec-2010 ,Level Approved on 28-Feb-2012 ,Level Approved on 07-Aug-2012 ,Level Approved on 28-Dec-2012 ,Level 2 Approved on 24-Mar-2015 Related Project(s) P130395-India: Karnataka Health Systems Additional Financing 2/3/2016 Page 8 of 8 Public Disclosure Copy