The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Disease Prevention and Control Project (P128442) EUROPE AND CENTRAL ASIA | Armenia | IBRD/IDA | Investment Project Financing (IPF) | FY 2013 | Seq No: 23 | Archived on 27-Jun-2024 | ISR00864 Implementing Agencies: Ministry of Health, HPIU 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 15-Sept-2013) The Project development objective is to improve (i) Maternal and Child Health(MCH) services and the prevention, early detection, and management of selected Non-Communicable Diseases (NCD) at the Primary Health Care (PHC) level; and (ii) the efficiency and qualityof selected hospitals in Armenia. Has the Development Objective been changed since Board Approval of the Project Objective? Yes Current Development Objective (Approved as part of Restructuring package Seq. 5 on 27-Mar-2020) The objective of the Project is to (i) increase the detection of selected NCDs at the PHC level and among pregnant mothers; (ii) improve the efficiency and quality of selected hospitals; and (iii) prevent, detect and respond to the threat posed by COVID-19. 2. COMPONENTS Name Emergency response to COVID-19:(Cost 3,750,000.00) Performance-based incentives to improve MCH and NCD services in primary care faci:(Cost 4,720,000.00) Hospital Modernization:(Cost 42,690,000.00) Project Management:(Cost 3,580,000.00) 3. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Satisfactory Satisfactory Jun 27, 2024 Page 1 of 12 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate 4. KEY ISSUES & STATUS 4.1 Implementation Status and Key Decisions The Armenia Disease Prevention and Control Project (DPCP) was approved by the World Bank’s Executive Board on March, 27, 2013 and became effective on July 22, 2013. The project will close on June, 30, 2024, and has disbursed approximately 100% of the original IDA credit of SDR22.8 million (equivalent to US$35 million), 100 percent of the US$1.8 million Health Results Innovation Trust Fund (HRITF) grant, and 100 percent of the US$7.4 million IBRD Additional Financing (AF) loan. Overall, Project Development Objective (PDO)-level indicators have mostly surpassed or achieved their end-of-project targets, including indicators for screening of key non-communicable diseases such as blood pressure, hypertension, diabetes, cervical cancer, etc., bed occupancy rates, and death rates following hospital discharges for acute myocardial infarction or pneumonia at two project-financed rehabilitated medical centers (Artashat and Sevan), and number of designated intensive care units that are fully equipped and functional, without stock-outs, in response to the COVID-19 pandemic. The construction, renovation, equipping of all six health facilities under the project are now completed and fully operational (Hematology Center, Artashat, Sevan, Vanadzor, Martuni, and Vayots Dzor Medical Centers). The World Bank will conduct an Implementation Completion and Results Report (ICR) preparation mission to Armenia in Q1 FY25. The final ICR report is due by December 31, 2024. 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Last Approved Rating Risk Category Approval Package - ISR Seq. 022 - 07 Dec Proposed Rating 16 Sep 2013 2023 Political and Governance Substantial Moderate Moderate Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Low Low Low Technical Design of Project or Program Low Low Low Institutional Capacity for Implementation and Substantial Moderate Moderate Sustainability Fiduciary Substantial Moderate Moderate Jun 27, 2024 Page 2 of 12 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Environment and Social Low Moderate Moderate Stakeholders Moderate Moderate Moderate Overall Moderate Moderate Moderate Jun 27, 2024 Page 3 of 12 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes To increase the detection of selected non-communicable diseases (NCDs) in Primary Health Care (PHC) Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Percentage of antenatal care 0.00 Jan/2013 94.80 31-Dec-2022 85.00 Jun/2024 (ANC) attendees screened for Comments on The 2024 end-of-Project target value has been surpassed. glycosuria, hypertension and achieving targets proteinuria in at least three antenatal visits (Percentage) (Percentage) Percentage of population a) 22.50b) Dec/2013 a) 40.2 b) 26.7 31-Dec-2022 a)39.00b)27.00 Jun/2024 aged 35-68 screened for 17.80 hypertension at least once in Comments on The 2024 end-of-Project target values have been surpassed for females and close to achieved the last year a) female; b) achieving targets for males. male (Percentage) (Text) a)9.80b)7.50 Dec/2013 a) 23.1 b) 14.8 31-Dec-2022 a)20.00b)15.00 Jun/2024 Percentage of population Comments on The targets of this under-performing indicator was revised in the September 2022 aged 35-68 screened for achieving targets restructuring to reflect the impact of the pandemic on health care seeking behavior. The diabetes mellitus at PHC level at least once during the last 3 indicator has made strong progress among both sexes since previously reported data in years a) female; b) male December 2021. Given the revised 2024 end-of-project targets, this indicator has been (Percentage) (Text) surpassed for females and close to being achieved for males. Percentage of women aged 8.50 Jan/2013 9.70 31-Dec-2022 10.00 Jun/2024 30-60 screened for cervical Comments on The target of this under-performing indicator was revised in the September 2022 restructuring cancer at least once during achieving targets to reflect the impact of the pandemic on health care seeking behavior. The indicator has made Jun 27, 2024 Page 4 of 12 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) the last 3 years and received progress since previously reported data from December 2021. Given the revised 2024 end-of- the results (Percentage) Project target value, this indicator is very close to being achieved (just 0.3 percentage point (Percentage) less than the target). To improve the efficiency and quality of selected hospitals in Armenia Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year a)64.00b)51.00 Jan/2013 a) 58.7b) 61.9 31-Aug-2023 a)70.00 Jun/2024 Bed occupancy rate at the a) b)70.00 Artashat Medical Center; b) Comments on This indicator achieved its end of project targets in December 2022. Current figures --while Sevan Medical Center achieving targets lower-- are based on August 2023 data and are expected to improve by the end of December (Percentage) (Text) 2023. Percentage of deaths 10.60 Dec/2013 3.60 04-Oct-2023 8.00 Jun/2024 following hospital discharges Comments on Indicator has surpassed its end-of-project target. for acute myocardial achieving targets infarction or pneumonia, in the last year, at Sevan and Artashat MCs (Percentage) (Number) To prevent, detect and respond to the threat posed by COVID-19 Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Number of designated 0.00 Jan/2013 5.00 31-Dec-2022 5.00 31-Dec-2022 4.00 Jun/2024 intensive care units that are Comments on The 2024 end-of-Project target value has been surpassed. fully equipped and achieving targets functional, without stock- outs in the final two weeks of Jun 27, 2024 Page 5 of 12 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) the calendar year (Number) (Number) 6.2 Intermediate Results Indicators by Components Emergency response to COVID-19 Indicator Baseline Actual (Previous) Actual (Current) Name Value Month/Year Value Date Value Date Number of 0.00 Jan/2013 70.00 31- 70.00 ventilators for Dec- management 2022 of COVID-19 Comments on achieving targets This indicator has met the 2024 end-of-Project t cases, financed through the Project (Number) (Number) Performance-based incentives to improve MCH and NCD services in primary care faci Indicator Baseline Actual (Previous) Actual (Current) Name Value Month/Year Value Date Value Date Percentage of 0.00 Jan/2013 98.30 31- 98.00 PHC facilities Dec- undergoing 2022 enhanced verification of results by the HPIU Jun 27, 2024 Page 6 of 12 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) (Percentage) (Percentage) Malea)45.00b)24.00c)55.00d)65.00e)33.00Femalea)58.00b)32.00c)64.00d)64.00e)42.00 Jan/2013 Male a) 27.4 31- Male a) 27.4 31- Malea) Percentage of (2012 HSPA data) b) 12.5c) Dec- b) 12.5c) Dec- adults aware 75.7d) 63.5 2022 75.7d) 63.5 2022 of key NCD e) e) risk factors a) 18.3Female 18.3Female high blood a) 48.6 b) a) 48.6 b) pressure; b) 26.8c) 26.8c) high 87.6d) 87.6d) cholesterol 76.5e) 76.5e) level; c) high 32.2(2022 32.2(2022 salt intake; d) HSPA data) HSPA data) obesity; e) Comments on achieving targets Actual values for this indicator were updated fo high glucose project targets for awareness of salt intake leve level factors is close to being achieved for both sexes (disaggregated pressure, high cholesterol, and glucose levels w by gender) (Percentage) (Text) Hospital Modernization Indicator Baseline Actual (Previous) Actual (Current) Name Value Month/Year Value Date Value Date Health 0.00 Jan/2013 5.00 15- 6.00 facilities Nov- constructed, 2023 renovated, Comments on achieving targets The following facilities have been completed: He and/or Martuni MC. The endline target value was revise equipped achieving its end-of-project values. Jun 27, 2024 Page 7 of 12 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) (Number) (Number) Number of 0.00 Jan/2013 316.00 31- 316.00 31- 300.00 hospital Dec- Dec- health 2022 2022 workers Comments on achieving targets The 2024 end-of-Project values have been achie receiving training on new clinical practice guidelines (Number) (Number) a)Not operational b)Not operational c)Not operational d)Not operational Jan/2013 a) 31- a) 31- a)Oper Operational, May- Operational, May- Medical b) 2024 b) 2024 Centers Operational, Operational, operational a) c) c) Sevan MC; b) Operational, Operational, Artashat MC; d) d) c) Martuni Operational Operational MC; d) Vayots Comments on achieving targets Artashat and Sevan MCs became operational on Dzor MC officially opened on November 5, 2023. Vayots D (Text) (Text) achieve the end-of-Project target values. Jun 27, 2024 Page 8 of 12 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Project Management Indicator Baseline Actual (Previous) Actual (Current) Name Value Month/Year Value Date Value Date Percentage of a)9.50 b)14.20 Oct/2020 a) 73.2 b) 31- a)70.00 workers under 86.7 Dec- the Project 2022 with adequate Comments on achieving targets This indicator has made strong progress since pr awareness of values. GBV, including SEA and SH, in the last year: a) Male; b) Female (Percentage) (Text) Percentage of a)0.00 b)0.00 Oct/2020 a) 100.00 b) 31- a)60.00 beneficiaries 100.00 Dec- in annual 2022 consultations Comments on achieving targets Annual consultations conducted with end-of-pro that express satisfaction with the Project, including the community engagement process: (a) Gegharkunik Jun 27, 2024 Page 9 of 12 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Marz (b) Vayots Dzor Marz (Percentage) (Text) Jun 27, 2024 Page 10 of 12 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) 7. DATA ON FINANCIAL PERFORMANCE 7.1 Cumulative Disbursements 7.2 Disbursements (by loan) Loan/Credit/TF Status Original Revised Cancelled Disbursed Undisbursed % Disbursed IBRD-92020 Effective 7.40 7.40 0.00 7.40 0.00 100.00% IDA-52220 Closed 35.00 34.99 0.00 32.28 0.00 92.25% TF-14138 Closed 1.80 1.80 0.00 1.80 0.00 100.00% 7.3 Key Dates (by loan) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing Jun 27, 2024 Page 11 of 12 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) IBRD-92020 Effective 04-Feb-2021 18-Feb-2021 14-Jun-2021 28-Feb-2023 30-Jun-2024 IDA-52220 Closed 27-Mar-2013 17-May-2013 22-Jul-2013 15-Dec-2019 30-Sept-2022 TF-14138 Closed 11-Jul-2013 27-Sept-2013 27-Sept-2013 31-Dec-2018 31-Dec-2019 8. KEY DATES Key Events Planned Actual Approval 26-Mar-2013 27-Mar-2013 Effectiveness Not Available 22-Jul-2013 Mid-Term Review No. 01 31-May-2017 12-Jun-2017 Operation Closing/Cancellation 30-Jun-2024 9. RESTRUCTURING HISTORY Restructuring Level 2 Approved on 07-Mar-2018 Restructuring Level 2 Approved on 26-Feb-2015 Restructuring Level 2 Approved on 06-Sept-2022 Restructuring Level 2 Approved on 26-Mar-2020 Restructuring Level 2 Approved on 14-Jan-2020 Restructuring Level 2 Approved on 17-Feb-2020 10. ASSOCIATED OPERATION(S) There are no associated operations Jun 27, 2024 Page 12 of 12