The World Bank Implementation Status & Results Report Strengthening the Digital Health Agenda in the Province of Buenos Aires (P179534) Strengthening the Digital Health Agenda in the Province of Buenos Aires (P179534) LATIN AMERICA AND CARIBBEAN | Argentina | IBRD/IDA | Investment Project Financing (IPF) | FY 2024 | Seq No: 3 | Archived on 10-Oct-2024 | ISR01820 Implementing Agencies: Provincial Directorate of Multilateral Organizations and Bilateral Financing 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 04-Jul-2023) Increase access to health services and improve coordination and continuity of care in the public healthcare network of the Province of Buenos Aires. Has the Development Objective been changed since Board Approval of the Project Objective? No 2. COMPONENTS Name Strengthening the Implementation of Electronic Medical Records (EMRs) / Integrated Health Record (IHR) in public health facilities:(Cost 39,100,000.00) Developing and Implementing Virtual Tools for Health Provision and Communication:(Cost 10,600,000.00) Project Management:(Cost 300,000.00) 3. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial 4. KEY ISSUES & STATUS Oct 10, 2024 Page 1 of 10 The World Bank Implementation Status & Results Report Strengthening the Digital Health Agenda in the Province of Buenos Aires (P179534) 4.1 Implementation Status and Key Decisions The Strengthening the Digital Health Agenda in the Province of Buenos Aires Project, financed by a US$50 million loan from the World Bank approved by the WB Board of Directors on July 5, 2023, and effective since December 13, 2023, aims to increase access to health services and improve coordination and continuity of care in the public healthcare network of the Province of Buenos Aires. Significant progress has been made in the early stages of the project, thirteen municipalities have signed participation agreements and begun implementing the Integrated Health System (HIS) in primary health facilities. HIS implementation has also started in 31 provincial hospitals. 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Last Approved Rating Risk Category Approval Package - ISR Seq. 02 - 16 Apr Proposed Rating 05 Jul 2023 2024 Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Moderate Moderate Moderate Sustainability Fiduciary Moderate Moderate Moderate Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Overall Substantial Substantial Substantial Oct 10, 2024 Page 2 of 10 The World Bank Implementation Status & Results Report Strengthening the Digital Health Agenda in the Province of Buenos Aires (P179534) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 0.00 Nov/2022 2.74 30-Jun-2024 2.74 30-Jun-2024 14.00 Dec/2027 Comments on These are preliminary results using the revised operational definition as of June 2024. achieving targets Performance will be reviewed by December 2024. Numerator: number of consultations provided by Health Facilities implementing IHR in municipalities covered by the Project, by gender. Percentage of consultations The number of consultations refers to the actual number of outpatient and inpatient properly registered in the consultations (excluding dental consultations) in eligible Health Facilities. IHR, by gender. - Denominator: total number of consultations registered in the Health Facility Performance (Percentage) System (SRES , Sistema de Rendimientos de Establecimientos de Salud), in municipalities covered by the project, by gender. The definition of "Consultations properly registered in the IHR" means that patient's key sociodemographic fields are registered (i.e.,unique identification, health coverage, home address and gender). In addition, fields in the IHR related to "reason for consultation" and/or "problems" and health professional who registered the service are filled. Percentage of women 25 to 6.50 30-Jun-2024 6.50 30-Jun-2024 64 years old with positive Comments on Same as previous PDI, these are preliminary Results. Numerator: adult women 25-64 year cervical cancer screening that achieving targets old with exclusive public health coverage and positive cervical cancer screening that have have received a colposcopy received a colposcopy or have a scheduled colposcopy consultation within a three-month or have a scheduled period in municipalities implementing IHR under the project. colposcopy consultation Denominator: adult women 25-64 year old with exclusive public health coverage and Oct 10, 2024 Page 3 of 10 The World Bank Implementation Status & Results Report Strengthening the Digital Health Agenda in the Province of Buenos Aires (P179534) within a three-month period. positive cervical cancer screening December 1 and 31 of each year registered in (Percentage) SITAM/SUMAR performance report in municipalities implementing IHR under the project. A cervical cancer screening is considered positive if: a) there is a positive PAP ASC-H/H-SIL or AGC or AIS/carcinoma result, b) Positive HPV qualitative and a positive PAP ASC-US (Atypical Squamous Cells of Undetermined Significance) result and c) a Positive HPV PCR for serotypes 16 and/or 18 result. To be counted as a positive case in the numerator, the women have received a colposcopy or have a scheduled colposcopy con 0.00 29-Sep-2023 Percentage of diabetics that received an eye fundus exam Comments on Numerator: number of people diagnosed with type 2 diabetes mellitus that received an eye through the tele- achieving targets fundus exam, according to recommendations in clinical practice guidelines, through the tele- ophthalmology strategy. ophthalmology strategy in selected locations. (Percentage) Denominator: estimation of the prevalence of type 2 diabetes mellitus in people with exclusive public coverage 6.2 Intermediate Results Indicators by Components Not Categorized Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 0.00 Nov/2022 17.14 30-Jun-2024 17.14 30-Jun-2024 30.00 Dec/2027 Comments on These are preliminary results using the revised operational definition as of June 2024. achieving targets Performance will be reviewed by December 2024. Absenteeism in scheduled Denominator: Number of women aged 25 to 64 with positive cervical cancer screening who colposcopy (Percentage) have scheduled a colposcopy consultation within three-months of positive screening in municipalities implementing IHR under the project Numerator: among those women in denominator with a scheduled colposcopy, those who actually did not receive the coloscopy service Oct 10, 2024 Page 4 of 10 The World Bank Implementation Status & Results Report Strengthening the Digital Health Agenda in the Province of Buenos Aires (P179534) 0.00 Nov/2022 13.00 30-Jun-2024 13.00 30-Jun-2024 30.00 Dec/2027 Comments on These are preliminary results using the revised operational definition as of June 2024. Municipalities that started achieving targets Performance will be reviewed by December 2024. implementing IHR (Number) Number of municipalities implementing IHR. A municipality is considered as "implementing IHR" if implementation of one module of IHR started in at least one Health Facility. Primary Health Care (PHC) 0.00 Nov/2022 0.00 30-Jun-2024 0.00 30-Jun-2024 150.00 Dec/2027 facilities with adequate ICT Comments on Number of primary health care facilities (PHC) with adequate ICT equipment. The PHC equipment (Number) achieving targets facilities refer to those facilities eligible for the IHR implementation. 0.00 Nov/2022 0.00 29-Sep-2023 40.00 Dec/2027 Hospital facilities with Comments on Number of eligible hospitals with adequate ICT equipment. Hospitals refer to those eligible adequate ICT equipment achieving targets facilities selected for IHR implementation. Adequate ICT equipment means having at least a (Number) desktop PC with a Windows operating system superior to XP; Memory 8 RAM; Chrome web browser in the admission area and at least in one outpatient clinic room 0.00 29-Sep-2023 150.00 Dec/2027 Comments on These are preliminary results using the revised operational definition as of June 2024. PHC facilities that received achieving targets Performance will be reviewed by December 2024. IHR training (Number) Number of eligible PHC facilities that received IHR training. A facility is considered that received training if its staff has been trained in at least one IHR module. 0.00 Nov/2022 38.00 30-Jun-2024 38.00 30-Jun-2024 40.00 Dec/2027 Comments on These are preliminary results using the revised operational definition as of June 2024. Hospital facilities that achieving targets Performance will be reviewed by December 2024. received IHR training (Number) Number of eligible hospital facilities that received IHR training. A facility is considered that received training if facility staff has been trained in at least one IHR module. 0.00 Nov/2022 0.00 29-Sep-2023 190.00 Dec/2027 Oct 10, 2024 Page 5 of 10 The World Bank Implementation Status & Results Report Strengthening the Digital Health Agenda in the Province of Buenos Aires (P179534) Comments on These are preliminary results using the revised operational definition as of June 2024. Health Facilities with IHR achieving targets Performance will be reviewed by December 2024. implemented and fully operational (Number) Number of eligible Health Facilities with IHR implemented and operational. IHR is considered implemented and operational if at least one IHR module is in used at the facility. 0.00 29-Sep-2023 334,114.00 Dec/2027 Comments on These are preliminary results using the revised operational definition as of June 2024. Patients with a consultation achieving targets Performance will be reviewed by December 2024. properly registered in the IHR, by gender (Number) Number of patients attending Health Facilities implementing IHR financed by the Project in targeted municipalities with at least one consultation properly registered in the IHR, by gender 0.00 Nov/2022 3.00 30-Jun-2024 3.00 30-Jun-2024 5.00 Dec/2027 Comments on These are preliminary results using the revised operational definition as of June 2024. achieving targets Performance will be reviewed by December 2024. Prioritized functionalities Number of prioritized functionalities developed. Functionalities refer to: developed (Number) Functionality 1 - Integration with RIS system Functionality 2 - Organization of two-way referral system integrated with appointment booking system Functionality 3 - Integration with Laboratory System Functionality 4 - Integration with Pharmacy System Functionality 5 - CDSS and Provincial Dashboard / data science and AI Selected municipalities with 0.00 Nov/2022 0.00 29-Sep-2023 4.00 Dec/2027 their own EMR solution Comments on Number of selected municipalities with their own EMR solution interoperable with the IHR interoperable with IHR achieving targets platform. Selected municipalities should comply with cybersecurity standards. platform (Number) 0.00 Nov/2022 4.00 30-Jun-2024 4.00 30-Jun-2024 20.00 Dec/2027 Oct 10, 2024 Page 6 of 10 The World Bank Implementation Status & Results Report Strengthening the Digital Health Agenda in the Province of Buenos Aires (P179534) Comments on These are preliminary results using the revised operational definition as of June 2024. Percentage of Health achieving targets Performance will be reviewed by December 2024. Facilities implementing digital two-way referral Numerator: Number of Health Facilities implementing IHR with the digital two-way referral. (Percentage) Denominator: Number of Health Facilities implementing IHR within the reference period. 35.00 Nov/2022 32.61 30-Jun-2024 32.61 30-Jun-2024 43.00 Dec/2027 Comments on These are preliminary results using the revised operational definition as of June 2024. achieving targets Performance will be reviewed by December 2024. Percentage of SUMAR beneficiaries with basic Numerator: People enrolled in SUMAR Program who received at least one health service effective coverage, by gender that provides basic effective coverage (CEB-Cobertura Efectiva Basica), within a 12-month (Percentage) period. Denominator: People enrolled in SUMAR Program within a 12-month period. The project is expected to have an impact on CEB by promoting continuity of care and expanding access to the health system. 0.00 Nov/2022 13.29 30-Jun-2024 13.29 30-Jun-2024 40.00 Dec/2027 Percentage of people Comments on These are preliminary results using the revised operational definition as of June 2024. registered in IHR with self- achieving targets Performance will be reviewed by December 2024. perceived gender identity (Percentage) Numerator: Number of people registered in IHR with self-perceived gender identity Denominator: Total number of people registered in IHR. 0.00 Nov/2022 0.00 29-Sep-2023 6.00 Dec/2027 Comments on These are preliminary results using the revised operational definition as of June 2024. Stages achieved in the achieving targets Performance will be reviewed by December 2024. development of the ecosystem for the virtual Stages achieved in the development of the ecosystem for the virtual healthcare operational healthcare operational center: center. (Number) Stage 1- Software development. Stage 2 - Portal. Stage 3 - Access to consultation with teleoperators. Oct 10, 2024 Page 7 of 10 The World Bank Implementation Status & Results Report Strengthening the Digital Health Agenda in the Province of Buenos Aires (P179534) Stage 4 - Access to Consultation with Basic Physicians. Stage 5 - Medication prescription access portal funded by the PBA Ministry of Health. Stage 6 - Integration with IHR. Citizen consultations 0.00 Nov/2022 0.00 30-Jun-2024 0.00 30-Jun-2024 150,000.00 Dec/2027 managed through the web Comments on Total consultations managed by teleoperators or medical professionals through the web portal of the PBA (Number) achieving targets portal of the PBA. Average number of days 31.00 Nov/2022 0.00 30-Jun-2024 0.00 30-Jun-2024 20.00 Dec/2027 between the prescription of Comments on Difference in days between date of medication prescription and date of medication pickup breast cancer medication and achieving targets for women with breast cancer living in municipalities implementing IHR (Average). the delivery of this Medication prescription for breast cancer refers to those treatment medicines included in medication to women with the Vademecum approved and financed by the Provincial Cancer Institute. exclusive public coverage. (Number) Percentage of people 0.00 Nov/2022 0.00 30-Jun-2024 0.00 30-Jun-2024 50.00 Dec/2027 satisfied with the use of the Comments on Numerator: Number of people who responded positively to the satisfaction survey declared Citizen Web Portal and achieving targets being satisfied with the use of Citizen Web Portal and Telemedicine applications. telemedicine applications Denominator: Number of responses to the satisfaction survey. (Percentage) The satisfaction survey will use a Likert scale to rate the degree of satisfaction Oct 10, 2024 Page 8 of 10 The World Bank Implementation Status & Results Report Strengthening the Digital Health Agenda in the Province of Buenos Aires (P179534) 7. DATA ON FINANCIAL PERFORMANCE 7.1 Cumulative Disbursements 7.2 Disbursements (by loan) Loan/Credit/TF Status Original Revised Cancelled Disbursed Undisbursed % Disbursed Historical Disbursed IBRD-95410 Effective 50.00 50.00 0.00 1.99 48.01 3.99% 50.00 7.3 Key Dates (by loan) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing IBRD-95410 Effective 05-Jul-2023 20-Oct-2023 13-Dec-2023 30-Apr-2027 30-Apr-2027 8. KEY DATES Oct 10, 2024 Page 9 of 10 The World Bank Implementation Status & Results Report Strengthening the Digital Health Agenda in the Province of Buenos Aires (P179534) Key Events Planned Actual Approval 05-Jul-2023 05-Jul-2023 Effectiveness 13-Dec-2023 13-Dec-2023 Mid-Term Review No. 01 16-Nov-2025 Operation Closing/Cancellation 30-Apr-2027 9. RESTRUCTURING HISTORY 10. ASSOCIATED OPERATION(S) There are no associated operations Oct 10, 2024 Page 10 of 10