The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) Tuvalu Health System Strengthening Project (P175170) EAST ASIA AND PACIFIC | Tuvalu | IBRD/IDA | Investment Project Financing (IPF) | FY 2022 | Seq No: 6 | Archived on 07- May-2025 | ISR03596 Implementing Agencies: Ministry of Health, Social Welfare and Gender Affairs 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 29-Jun-2022) The Project Development Objectives (PDOs) are to improve delivery of select health services, strengthen health management systems, and in case of an Eligible Crisis or Emergency, respond promptly and effectively to it. Has the Development Objective been changed since Board Approval of the Project Objective? No 2. COMPONENTS Name Improve the Availability of Essential Public Health and Health Care Services Provided at Princess Margaret Hospital:(Cost 9,910,000.00) Strengthen the Delivery of Primary Health Care and Primary Prevention, with a Focus on Non-Communicable Diseases:(Cost 3,020,000.00) Support the Development of Management Systems:(Cost 2,070,000.00) Contingent Emergency Response Component (CERC):(Cost 0.00) 3. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Moderate Moderate May 08, 2025 Page 1 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) 4. KEY ISSUES & STATUS 4.1 Implementation Status and Key Decisions The World Bank conducted an implementation support mission for the Tuvalu Health System Strengthening Project (THSSP) from March 10 to 13, 2025. The project has achieved disbursements of US$7 million, representing 47 percent of its total financing, driven by procurements addressing immediate health system needs and the implementation of the United Nations Office for Project Services (UNOPS) contract for constructing a new wing at Princess Margaret Hospital (PMH), equipping it, and enhancing outer island clinics to strengthen primary health care (PHC). To sustain this progress and achieve the project’s objectives, the following key actions are prioritized: • Finalize the UNOPS contract amendment to expand Primary Health Care (PHC) investments from focused water, sanitation, and hygiene (WASH) improvements to comprehensive upgrades for all 11 outer island clinics, including medical equipment. • Submit Terms of Reference for key consultancies to enhance health workforce training and digital health services. • Conduct a joint Mid-Term Review by October 2025 to assess progress and recommend any course adjustments. 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Last Approved Rating Risk Category Approval Package - ISR Seq. 05 - 28 Oct Proposed Rating 29 Jun 2022 2024 Political and Governance Moderate Moderate Moderate Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Moderate Moderate Sustainability Fiduciary Substantial Substantial Moderate Environment and Social Moderate Moderate Moderate Stakeholders Low Low Low May 08, 2025 Page 2 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) Overall Substantial Moderate Moderate May 08, 2025 Page 3 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes Improve Delivery of Select Health Services Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year No service Jun/2022 No service 10-Oct-2024 No service 01-Apr-2025 Availability of Jun/2028 improvement improvement improvement services increased at Increase in the availability of PMH in at least essential hospital services at four service Princess Magraret Hospital areas (Text) Comments on By mid-April 2025, UNOPS will deliver: (i) a draft health services provision plan, (ii) a draft achieving targets demolition plan, and (iii) a draft Environmental and Social Management Plan (ESMP) for the demolition phase, pending asbestos test results. A draft PMH layout plan is due by June 30, 2025, requiring Ministry of Health (MoH) input to proceed to design. No increase in Jun/2022 Physical 10-Oct-2024 Physical 01-Apr-2025 Availability of Jun/2028 capacity expansion and expansion and Tracer Services Human Human Defined as Resource Resource part of agreed Increase in the Development Development Service Plan Diagnostic (radiological Plan in Plan in and laboratory) Progress (refer Progress (refer Capacity (Text) to IR to IR indicators) indicators) Comments on Intermediate target 1 achieved. Needs assessment completed and HR plan under achieving targets development (as per IR indicators) May 08, 2025 Page 4 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) No increase in Jun/2022 Physical 10-Oct-2024 Physical 01-Apr-2025 Availability of Jun/2028 capacity expansion and expansion and Tracer Services Human Human Defined as Resource Resource part of agreed Increase in the General Development Development Service Plan Surgery Capacity Plan in Plan in (Text) Progress (refer Progress (refer to IR to IR indicators) indicators) Comments on Intermediate target 1 achieved. Needs assessment completed and HR plan under achieving targets development (as per IR indicators) No increase in Jun/2022 Physical 10-Oct-2024 Physical 01-Apr-2025 Availability of Jun/2028 capacity expansion and expansion and Tracer Services Human Human Defined as Resource Resource part of agreed Increase in the mental Development Development Service Plan health and counseling Plan in Plan in capacity (Text) Progress (refer Progress (refer to IR to IR indicators) indicators) Comments on Intermediate target 1 achieved. Needs assessment completed and HR plan under achieving targets development (as per IR indicators) No increase in Jun/2022 Physical 10-Oct-2024 Physical 01-Apr-2025 Availability of Jun/2028 capacity expansion and expansion and Tracer Services Increase in the Human Human Defined as Integrated NCD Resource Resource part of agreed Management Capacity Development Development Service Plan (Text) Plan in Plan in Progress (refer Progress (refer May 08, 2025 Page 5 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) to IR to IR indicators) indicators) Comments on Intermediate target 1 achieved. Needs assessment completed and HR plan under achieving targets development (as per IR indicators) Increase in the percentage of 0.00 Jun/2022 14 10-Oct-2024 14 01-Apr-2025 50.00 Jun/2028 screened adults with a 10- Comments on Proxy data available only: As of 2024 there were cumulatively 1998 persons screened for year cardiovascular disease achieving targets NCD. This is calculated as the "Number of Registrations." Of these registered people, 90% (CVD) risk ≥30% or with were visited at home, and 253 (14%) were referred for further management. Since there is existing hypertension or no monitoring system in place it is not known how many of these 253 patients are currently diabetes that are being being treated and how they are being treated. managed for their condition (Percentage) Percentage of Managed 0.00 Jun/2022 0.00 10-Oct-2024 0.00 01-Apr-2025 50.00 Jun/2028 NCD Patients - Female Comments on No data. To be revised at MTR. (Percentage) achieving targets Percentage of Managed 0.00 Jun/2022 0.00 10-Oct-2024 0.00 01-Apr-2025 50.00 Jun/2028 NCD Patients - Male Comments on No data. To be revised at MTR. (Percentage) achieving targets Strengthen Health Management Systems Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year No established Jun/2022 No established 10-Oct-2024 Local 01-Apr-2025 Analysis from Jun/2028 Public feedback mechanism system for system for consultant Public operational, feedback receiving or receiving or recruited (3rd Feedback analyzed and published in responding to responding to Mar 2025) System Ministry of Health, Social public or public or included in Welfare and Gender Affairs’ patient patient Annual Health Annual Report (Text) feedback feedback Report (complaints, (complaints, May 08, 2025 Page 6 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) feedback, feedback, suggestions, suggestions, comments) comments) Comments on Related activity underway. achieving targets 6.2 Intermediate Results Indicators by Components Improve the Availability of Essential Public Health and Health Care Services Provided at Princess Margaret Hospital Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year No extension Jun/2022 Needs 10-Oct-2024 Needs 01-Apr-2025 New PMH Wing Jun/2028 of PMH Assessment Assessment Constructed, Underway Underway Equipped and PMH Physical Capacity Put into Increased (Text) Operation Comments on Target 2 in progress. By mid-April 2025, UNOPS will deliver: (i) a draft health services achieving targets provision plan, (ii) a draft demolition plan, and (iii) a draft Environmental and Social Management Plan (ESMP) for the demolition phase, pending asbestos test results. No Plan Jun/2022 Human 10-Oct-2024 Human 01-Apr-2025 HR Jun/2028 Resource Resource Development Development Development Plan Plan under Plan under Implemented PMH Human Resource preparation preparation including (i) Capacity Increased (Text) contractual human resources through May 08, 2025 Page 7 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) teleconsultation or in-country assignments; (ii) short-term training of PMH health professionals; (iii) short-term stays of visiting medical teams Comments on TOR for HR strategy plan to be finalized in step by April 30. achieving targets Strengthen the Delivery of Primary Health Care and Primary Prevention, with a Focus on Non-Communicable Diseases Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 0.00 Jun/2022 7,571 10-Oct-2024 7,714 01-Apr-2025 239,631.00 Dec/2027 People who have received Comments on 2024 – 7571 (Jan – Oct) essential health, nutrition, achieving targets 2025 – 143 (Nov 2024 – Mar 2025) and population (HNP) services (Number) 2024 – Only November Only outer islands 2025 – Only inpatients People who have 0.00 N/A N/A 121,014.00 received essential Comments on Pending HIS data. health, nutrition, and achieving targets population (HNP) services - Female (RMS requirement) (Number) May 08, 2025 Page 8 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) 0.00 Dec/2021 146 10-Oct-2024 459 01-Apr-2025 1,500.00 Dec/2027 Comments on August 2024 – 146 achieving targets October 2024 – January 2025 - 313 Number of children Oct – 79 immunized (Number) Nov – 80 Dec – 58 Jan - 96 (September missing). 0.00 Jun/2022 46 10-Oct-2024 948 10-Oct-2024 0.00 Dec/2027 Comments on Jan - August 2024 – 49 Number of women and achieving targets October 2024 – January 2025 - 899 children who have Oct – 244 received basic nutrition Nov – 209 services (Number) Dec – 184 Jan – 262 Mothers + babies. Number of deliveries 0.00 Jun/2022 162 10-Oct-2024 252 01-Apr-2025 1,500.00 Dec/2027 attended by skilled health personnel (Number) Adult Population Screened 0.00 Jun/2022 34 10-Oct-2024 24 01-Apr-2025 40.00 Jun/2028 for Non-Communicable Comments on Recalculated. Disease (Percentage) achieving targets Percentage of Adult 0.00 Jun/2022 N/A 10-Oct-2024 N/A 01-Apr-2025 50.00 Jun/2028 Population Screened Comments on Sex-disaggregation of parent indicator (female) that are Female achieving targets (Percentage) 0.00 Jun/2022 N/A 10-Oct-2024 N/A 01-Apr-2025 50.00 Jun/2028 May 08, 2025 Page 9 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) Percentage of Adult Comments on Sex-disaggregation of parent indicator (male) Population Screened achieving targets that are Male (Percentage) Number of health facilities 0.00 Jun/2022 0.00 10-Oct-2024 0.00 01-Apr-2025 11.00 Jun/2028 maintaining service readiness Comments on Guidelines are not yet developed and facilities have not been inspected. according to guidelines achieving targets (Number) 42.00 Dec/2020 43 10-Oct-2024 43 01-Apr-2025 50.00 Dec/2027 Comments on 2023 – 42 Progress Against MANA achieving targets 2024 – 43 Framework for NCD Primary L3 Explicit NCD indicators and targets Prevention (Number) Reduce harmful use of alcohol by 18.7% Improve physical activity by 25% Reduce tobacco use by 10% Reduce obesity by 25% 0.00 Jun/2022 24 10-Oct-2024 24 01-Apr-2025 70.00 Dec/2027 Comments on September update: Project activities related to first responder training are at the early achieving targets consultation stage with Gender and Social Welfare units. Percent of identified First Responders with knowledge to provide appropriate GBV services (detection, response Definition at appraisal: First responders would include counselors, police cadre and specified and referral) (Percentage) health workforce. Numerator = those who have been trained according to the guidelines and who demonstrate increased knowledge (i.e. through pre-test and post-test analysis). Denominator will be defined as part of the program development. System established for No Jun/2022 No 10-Oct-2024 No 01-Apr-2025 Yes Dec/2027 collecting sex-disaggregated Comments on Digital Health Strategy TOR not yet formulated. data on screening and achieving targets May 08, 2025 Page 10 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) management of NCD patients (Yes/No) Support the Development of Management Systems Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year No Asset Jun/2022 No Asset 10-Oct-2024 No Asset 01-Apr-2025 Asset Dec/2027 Management Management Management Management System exists System exists System exists System with an inventory of all major medical equipment and physical building assets established and Asset Management System maintained Established and Maintained Comments on September update: The project is in early consultations with the DFAT-funded biomedical (Text) achieving targets consultant at PMH to assess the asset management needs and to define the project work package of support. Definition at appraisal: The Asset Management System is system with an inventory of all significant assets (medical equipment, information systems, information communication technologies, physical buildings) that would improve the life-cycle approach to managing those assets. Strategy determined for Current Jun/2022 Current 10-Oct-2024 Current 01-Apr-2025 A strategy Dec/2027 having functional and fit for Hospital Hospital Hospital would be purpose Hospital Management Management Management agreed for Management Information Information Information Information adapting or System (Text) does not fully does not fully does not fully replacing HMIS May 08, 2025 Page 11 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) work across work across work across with a costed hospital hospital hospital and specific departments, departments, departments, action plan is designed for is designed for is designed for a large tertiary a large tertiary a large tertiary facility, facility, facility, includes text includes text includes text in foreign in foreign in foreign characters, characters, characters, and is not and is not and is not sufficiently sufficiently sufficiently maintained. maintained. maintained. Comments on September update: Related project activities to assess the HMIS are at the early consultation achieving targets stage. Definition at appraisal: The strategy will include an assessment of the existing system and the health information echo-system; definition of the functionality (clinical, administrative, technical) required; definition of the context in terms of human resources, technical capabilities, etc.; analysis of options to replace or update of the HMIS based on cost and feasibility; and detailed plan based on the preferred option. No System in Jun/2022 Terms of 10-Oct-2024 The detailed 01-Apr-2025 A public Dec/2027 Place reference for design of the feedback the design of public system is Public Feedback System the public feedback operational Designed and Established for feedback system the Health System (Text) system agreed initiated Comments on Target 2 achieved achieving targets May 08, 2025 Page 12 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) May 08, 2025 Page 13 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) 7. DATA ON FINANCIAL PERFORMANCE 7.1 Cumulative Disbursements 7.2 Disbursements (by loan) Loan/Credit/TF Status Original Revised Cancelled Disbursed Undisbursed % Disbursed IDA-E0860 Effective 15.00 15.17 0.00 7.09 7.89 47.33% 7.3 Key Dates (by loan) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing IDA-E0860 Effective 29-Jun-2022 19-Jul-2022 03-Aug-2022 30-Jun-2028 30-Jun-2028 8. KEY DATES May 08, 2025 Page 14 of 15 The World Bank Implementation Status & Results Report Tuvalu Health System Strengthening Project (P175170) Key Events Planned Actual Approval 29-Jun-2022 29-Jun-2022 Effectiveness 03-Aug-2022 03-Aug-2022 Mid-Term Review No. 01 15-Oct-2025 Operation Closing/Cancellation 30-Jun-2028 9. RESTRUCTURING HISTORY 10. ASSOCIATED OPERATION(S) There are no associated operations May 08, 2025 Page 15 of 15