FOR OFFICIAL USE ONLY
Report No: PP00014
INTERNATIONAL DEVELOPMENT ASSOCIATION
PROJECT PAPER
ON A
PROPOSED ADDITIONAL GRANT
IN THE AMOUNT OF US$4,821,650
TO THE
KINGDOM OF CAMBODIA
FOR A
CAMBODIA HEALTH EQUITY AND QUALITY IMPROVEMENT PROJECT - PHASE 2
{December 5, 2024}
Health, Nutrition, and Population
East Asia and Pacific Region
This document has a restricted distribution and may be used by recipients only in the performance of their official
duties. Its contents may not otherwise be disclosed without World Bank authorization.
CURRENCY EQUIVALENTS
(Exchange Rate Effective July 31, 2024)
Currency Unit = Cambodia Riel (KHR)
US$1 = KHR 4,107.96
FISCAL YEAR
January 1 - December 31
Regional Vice President: Manuela V. Ferro
Regional Director: Alberto Rodriguez
Country Director: Mariam J. Sherman
Practice Manager: Caryn Bredenkamp
Task Team Leaders: Ha Thi Hong Nguyen, Nareth Ly
ABBREVIATIONS AND ACRONYMS
AAR After-Action Review IVA Independent Validation Agent
ACM Asbestos-Containing Material IVT Independent Validation Team
AF Additional Financing JEE Joint External Evaluation
AM Accountability Mechanism KfW Kreditanstalt für Wiederaufbau (German
Development Bank)
AMR Antimicrobial Resistance M&E Monitoring and Evaluation
AOP Annual Operational Plan MAFF Ministry of Agriculture, Fishery and Forestry
DA Designated Account MDTF Multi-Donor Trust Fund
DCDC Department of Communicable Disease MEF Ministry of Economy and Finance
Control
CCS&T Cervical Cancer Screening and Treatment MOH Ministry of Health
CERC Contingent Emergency Response MSS Multisource Surveillance
Component
CNP Cambodia Nutrition Project MTR Midterm Review
CPF Country Partnership Framework NCD Noncommunicable Disease
D&D Decentralization and De-concentration NDC Nationally Determined Contribution
DBF Department of Budget and Finance NIPH National Institute of Public Health
DHS Department of Hospital Service NPCA National Payment Certification Agency
DHS&T Diabetes and Hypertension Screening NPHL Network of Public Health Laboratory
and Treatment
DPHI Department of Planning and Health NQEMTs- National Quality Enhancement Monitoring Tools
Information II Phase 2
EAR Early-Action Review NSSF National Social Security Fund
EID Emerging Infectious Disease OD Operational District
ERP Emergency Response Service OHS Occupational Health and Safety
ESCP Environment and Social Commitment OH-RRT One Health-Rapid Response Team
Plan
ESF Environmental and Social Framework OOP Out of Pocket
ESMF Environmental and Social Management OPD Outpatient Department
Framework
ESRC Environmental and Social Risk PBC Performance-Based Condition
Classification
ESS Environmental and Social Standards PCA Payment Certification Agency
FAO Food and Agriculture Organization of the PCR Polymerase Chain Reaction
United Nations
GBV Gender-Based Violence PDO Project Development Objective
GESI Gender Equality and Social Inclusion PF Pandemic Fund
GFF Global Financing Facility PHD Provincial Health Department
GIIP Good International Industry Practices PMD Preventive Medicine Department
GLLP Global Laboratory Leadership Program PMRS Patient Management and Registration System
GMAG Gender Mainstreaming Action Group POE Point of Entry
GRM Grievance Redress Mechanism POM Project Operating Manual
GRS Grievance Redress Service PPR Prevention, Preparedness, and Response
HC Health Center QAO Quality Assurance Office
HCF Health Care Facility QIWG Quality Improvement Working Group
HCW Health Care Waste RGC Royal Government of Cambodia
HCWM Health Care Waste Management RH Referral Hospital
HEF Health Equity Fund SDG Service Delivery Grant
HEIS Hands-on Expanded Implementation SEP Stakeholder Engagement Plan
Support
HEQIP-II Health Equity and Quality Improvement SOP Standard Operating Procedure
Project Phase 2
HF Health Facility STEP Systematic Tracking of Exchanges in
Procurement
HLO High-Level Outcome TA Technical Assistance
HNP Health, Nutrition, and Population TAD Transboundary Animal Diseases
ICT Information and Communication TF Trust Fund
Technology
IDA International Development Association TOR Terms of Reference
IEC Information, Education, and TOT Training of Trainers
Communication
IFR Interim Financial Report UHC Universal Health Coverage
IPD Inpatient Department USCDC United States Center for Disease Control and
Prevention
IPF Investment Project Financing WHO World Health Organization
IRI Intermediate Results Indicator
TABLE OF CONTENTS
I. BACKGROUND AND RATIONALE FOR ADDITIONAL FINANCING ........................................................................... 1
II. DESCRIPTION OF ADDITIONAL FINANCING............................................................................................................ 4
III. KEY RISKS .............................................................................................................................................................. 10
IV. APPRAISAL SUMMARY ......................................................................................................................................... 11
VI. PROPOSED CHANGES ........................................................................................................................................... 14
VII. DETAILED CHANGE(S) ........................................................................................................................................... 15
The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
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OPERATION INFORMATION
BASIC DATA - MAIN
Product Information - Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368)
Operation ID Product/Financing Instrument
P173368 Investment Project Financing (IPF)
Task Team Leaders
Ha Thi Hong Nguyen, Nareth Ly
Beneficiary Country/Countries Geographical Identifier
Cambodia Cambodia
Requesting Unit Responsible Unit
EAVCL (5185) HEAH2 (10560)
Approval Date Closing Date
10-Mar-2022 31-Dec-2027
Practice Area (Lead) Approval Fiscal year
Health, Nutrition & Population 2022
Environmental and Social Risk Classification (ESRC)
Substantial
Is there collaboration between Bank and IFC?
No
Implementing Agency
Ministry of Health, National Payment Certification Agency
IMPLEMENTATION MODALITIES – MAIN
Situations of Urgent Need of Assistance or Capacity Constraints
[ ] Fragile State(s) [ ] Fragile within a non-fragile Country
[ ] Small State(s) [ ] Conflict
[ ] Responding to Natural or Man-made Disaster
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
Other Situations
[ ] Financial Intermediaries (FI) [ ] Series of Projects (SOP)
[✓] Performance-Based Conditions (PBCs) [✓] Contingent Emergency Response Component (CERC)
[ ] Alternative Procurement Arrangements (APA) [ ] Hands-on Expanded Implementation Support (HEIS)
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OPERATION STATUS
Development Objective (DO)
Current Development Objective (Approved as part of Additional Financing package on 05-Dec-2024)
The PDO is to improve equitable utilization of quality health services, to strengthen capacity for health emergency
prevention, preparedness, and response, and to provide immediate and effective response in case of an Eligible Crisis
or Emergency in the Kingdom of Cambodia.
Key Information from Last ISR
Operation Ratings
NAME IMPLEMENTATION LAST ISR
RATINGS
13-Jan-2023 07-Jul-2023 16-Jan-2024 22-Mar-2024 03-Oct-2024
Progress towards ⚫ Moderately ⚫ Moderately ⚫ Moderately ⚫ Moderately ⚫ Moderately
achievement of Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory
PDO
Overall ⚫ Moderately ⚫ Moderately ⚫ Moderately ⚫ Moderately ⚫ Moderately
Implementation Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory
Progress (IP)
Overall Risk ⚫ Substantial ⚫ Substantial ⚫ Substantial ⚫ Substantial ⚫ Substantial
Overall ESS ⚫ ⚫ ⚫ ⚫ ⚫ Moderately
Performance Satisfactory
Financial ⚫ Moderately ⚫ Moderately ⚫ Moderately ⚫ Moderately ⚫ Moderately
Management Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory
Project ⚫ Moderately ⚫ Moderately ⚫ Moderately ⚫ Moderately ⚫ Moderately
Management Satisfactory Satisfactory Satisfactory Satisfactory Unsatisfactory
Procurement ⚫ Satisfactory ⚫ Moderately ⚫ Moderately ⚫ Moderately ⚫ Moderately
Satisfactory Satisfactory Satisfactory Unsatisfactory
Monitoring and ⚫ Satisfactory ⚫ Satisfactory ⚫ Satisfactory ⚫ Satisfactory ⚫ Satisfactory
Evaluation
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
Disbursement Summary (in USD million)
Source of Funds Net Commitment Disbursed Undisbursed % Disbursed
IBRD -- -- -- 0
IDA 52.02 18.26 33.67 35.16
Grants 41.03 18.29 22.70 44.62
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BASIC DATA – ADDITIONAL FINANCING
Additional Financing No. 3
Additional Financing Type
[✓] Activities are being added to expand the scope of the operation, perhaps in geography or in outputs (Scale-up)
The operation has incurred increased costs due to inflation, exchange rate changes, and factors that were not
[ ]
anticipated at appraisal (Cost-overrun)
The operation has experienced shortfalls in co-financing, counterpart financing, or cost recovery that were
[ ]
anticipated at appraisal but did not materialize. (Financing gap)
[ ] Is this Additional Financing being used to replenish financing due to CERC or RRO activation?
The design of the operation has changed, and the new designs cost more than the original ones (Change in Project
[ ]
Design)
Expected Approval Date Review Type/Corporate Review Level
06-Dec-2024 Regular Decision Meeting (DM)
Will consulting services be required? Is this an Urgent Need or Capacity Constraint request?
TBD No
IMPLEMENTATION MODALITIES – ADDITIONAL FINANCING
Situations of Urgent Need of Assistance or Capacity Constraints
[ ] Fragile State(s) [ ] Fragile within a non-fragile Country
[ ] Small State(s) [ ] Conflict
[ ] Responding to Natural or Man-made Disaster
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
Other Situations
[ ] Financial Intermediaries (FI) [ ] Series of Projects (SOP)
[✓] Performance-Based Conditions (PBCs) [✓] Contingent Emergency Response Component (CERC)
[ ] Alternative Procurement Arrangements (APA) [ ] Hands-on Expanded Implementation Support (HEIS)
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COSTS & FINANCING
Summary (Total Financing in US$, Millions)
Proposed
Last Approved Additional Cancellation Total
Total Operation Cost 303.82 0.00 0.00 303.82
Total Financing 303.82 0.00 0.00 303.82
Of which IBRD/IDA 55.00 0.00 0.00 55.00
Financing Gap 0.00 0.00
Financing Details (in US$, Millions)
Proposed
Source Last Approved Additional Cancellation Total
Counterpart Funding 186.00 0.00 0.00 186.00
Borrower/Recipient 186.00 0.00 0.00 186.00
International
Development 55.00 0.00 0.00 55.00
Association (IDA)
IDA Credit 55.00 0.00 0.00 55.00
Trust Funds 62.82 0.00 0.00 62.82
Miscellaneous 1 19.00 0.00 0.00 19.00
Global Financing Facility 15.00 0.00 0.00 15.00
Miscellaneous 2 28.82 0.00 0.00 28.82
Total Financing 303.82 0.00 0.00 303.82
IDA Resources (in US$, Millions)- Additional Financing
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
Guarantee
Credit Amount Grant Amount SML Amount Total Amount
Amount
National
Performance-Based 55.00 0.00 0.00 0.00 55.00
Allocations (PBA)
Total 55.00 0.00 0.00 0.00 55.00
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SYSTEMATIC OPERATIONS RISK- RATING TOOL (SORT)
Last Approved Rating
Risk Category (AF Seq. 01 Approval) Package - 05 Dec Proposed Rating
2024
Political and Governance ⚫ Moderate ⚫
Macroeconomic ⚫ Moderate ⚫
Sector Strategies and Policies ⚫ Moderate ⚫
Technical Design of Project or Program ⚫ Moderate ⚫
Institutional Capacity for
⚫ Substantial ⚫
Implementation and Sustainability
Fiduciary ⚫ Substantial ⚫
Environment and Social ⚫ Substantial ⚫ Substantial
Stakeholders ⚫ Moderate ⚫
Overall ⚫ Substantial ⚫
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CLIMATE
Climate Change and Disaster Screening
Has this operation been screened for short-term and long-term climate change and disaster risks?
Yes, it has been screened and the results are discussed in the Operation Document
Where risks exist, have potential resilience-enhancing measures been identified in the appraisal document?
Yes
Does this operation address specific risks, vulnerabilities, gaps or needs with respect to Climate Change that are identified in
the SCD or the CPF?
Yes
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
POLICY COMPLIANCE
Does the operation depart from the CPF in content or in other significant respects? No
Does the operation require any waivers from Bank policies? No
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
TEAM
Core Team
Name Role Specialization ADM Responsible?
Ha Thi Hong Nguyen Team Leader Yes
Nareth Ly Team Leader No
Financial Management
Kyemon Soe Yes
Specialist
Latharo Lor Procurement Specialist Yes
Kalesh Kumar
Senior Procurement
Anandavalliamma Procurement Specialist No
Specialist
Karunakarakurup
Sereyvattana Chan Procurement Specialist Procurement No
Kate Almora Philp Environmental Specialist Yes
Alexandra Annabelle
Social Specialist Yes
Niesslein
Marie Aria Nezam Counsel Legal No
Vitra Tek Procurement Team No
Pheara Lek Procurement Team No
Florou Hernandez Team Member Disbursement No
Owusu Mensah Agyei Team Member Disbursement No
Extended Team
Name Title Organization Location
Pooling Partners
Khemara Sun World Bank Cambodia
Coordinator
Reaksmey Keo Sok FM Specialist The World Bank Cambodia
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
I. BACKGROUND AND RATIONALE FOR ADDITIONAL FINANCING
A. Introduction
1. This Project Paper seeks the approval of the Regional Vice President for Additional Financing (AF)1 to the Health
Equity and Quality Improvement Project - Phase 2 (HEQIP-II, P173368) in the form of a grant from the Pandemic Fund
(PF) in the amount of US$4.82 million. The PF aims to help developing countries respond to the current crisis and improve
their preparedness for future health emergencies.2 The AF aims to scale up the parent project to support efforts of the
Royal Government of Cambodia (RGC) to increase prevention, preparedness, and response (PPR) for future public health
emergency in Cambodia.
B. Status of Parent Project
2. The parent project, with a total financing of US$299 million, was approved on March 10, 2022, and became
effective on July 7, 2022. The project financing comprises US$186 million from the RGC; US$55 million equivalent from
International Development Association (IDA) (credit No 7046-KH); and US$58 million in grant from three different trust
funds (TFs): (a) US$15 million from the Multi-Donor Trust Fund (MDTF) for Global Financing Facilities in Support of Every
Woman and Every Child (GFF) (Grant No TF0B7735); (b) US$19 million from the Australia-World Bank Partnership for
Promoting Inclusion, Sustainability, and Equality in Cambodia Single Donor Trust Fund (Grant No TF0B7732); and (c) US$24
million from the MDTF from German Development Bank (Kreditanstalt für Wiederaufbau, KfW) and Korean International
Cooperation Agency (Grant No TF0C0243). The Project Development Objective (PDO) is to improve equitable utilization
of quality health services in Cambodia, especially for the poor and vulnerable populations, and provide immediate and
effective response in case of an eligible crisis or emergency in the Kingdom of Cambodia. The project comprises four
components: (a) Component 1: Improving Financial Protection and Utilization of Health Equity Fund (HEF) (US$112.0
million); (b) Component 2: Strengthening Quality and Capacity of Health Service Delivery (US$183.3 million); (c)
Component 3: Project Management, Monitoring and Evaluation (M&E), Gender Equality and Social Inclusion (GESI)
(US$3.7 million); and (d) Component 4: Contingent Emergency Response (US$0.0).
3. Progress toward achievement of the PDO and implementation progress remains Moderately Satisfactory.3 As
of November 20, 2024, out of 18 PDO indicators and sub-indicators, 2 have achieved Year 1 target, 3 have not achieved,
and 13 are yet to be measured. Out of 20 intermediate results indicators (IRIs) and sub-indicators, 9 have achieved Year 1
targets, 7 have not achieved, and 4 are yet to be measured. Regarding the performance-based conditions (PBCs), out of
19 targets for Year 1 of the seven PBCs, it is likely that 7 PBC targets will be confirmed as achieved, and 2 have partially
achieved their Year 1 target (subject to confirmation from independent validation).
1
This is the first AF. Since it was created in Operation Portal version 3 while the parent project was migrated to OWS, the AF was dropped,
canceled, and recreated in the Operation Workspace as AF 3 on page iii.
2 Cambodia constitutes 1 of the 19 winning proposals in the first round of call for proposals from the PF. The US$19 million proposal prioritized
strengthening three key areas in human and animal health: (a) surveillance, (b) laboratory capacities, and (c) human resources, all within the
framework of One Health. Of US$19 million, US$4.82 million will be allocated to the Ministry of Health (MOH) for activities focusing on human
health and to be implemented through a World Bank-financed project. Of the remaining amount, US$3.45 million will be designated for the Food
and Agriculture Organization of the United Nations (FAO)/Ministry of Agriculture, Fishery and Forestry (MAFF) to address animal health concerns;
and US$10 million will be provided to the Asian Infrastructure Investment Bank (AIIB)/MAFF to facilitate the refurbishment of animal vaccine
centers, establishment of disease control zones, renovation of animal research institutes, and drafting of policy papers.
3 As of the last Implementation Status and Results Report, dated October 3, 2024.
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
4. Disbursement is at 39 percent,4 of which IDA at 35 percent and three TFs at 45 percent. The project progress by
component is elaborated in the following paragraphs.
Component 1: Improving Financial Protection and Utilization of the HEF (US$112 million, of which US$70 million from
the RGC)
5. This component provides financing to the HEF and seeks to improve its management and utilization. The
Government has shown a strong commitment to provide free services for the poor and vulnerable population, reflected
in the recent inclusion of the at-risk households in the HEF beneficiaries. There was a noticeable improvement in
outpatient contacts in 39 low-utilization operational districts (ODs), from 0.44 in 2022 to 0.50 in 2023. In 2023, the
outpatient contacts per HEF beneficiary was 0.89 per capita compared to 0.61 among the general population. However,
no significant progress has been made in promoting awareness of the HEF benefits to its intended beneficiaries including
newly added at-risk groups. The Department of Planning and Health Information (DPHI) will initiate formal communication
with the Ministry of Planning to mobilize commune/sangkat offices to disseminate information on HEF benefits to at-risk
households and work with the National Health Promotion Center to disseminate information, education, and
communication (IEC) material produced under the Cambodia Nutrition Project (CNP) in non-CNP provinces and use social
media for HEF promotion.
6. As for the benefit package update, a Concept Note was approved; however, progress has been slow. It was
agreed that in lieu of Phase 1 revision, the Ministry of Health (MOH) will allocate the noncommunicable disease (NCD)
drugs being procured with additional US$11 million from the national budget for the HEF and National Social Security Fund
(NSSF) beneficiaries for the second half of 2024. The HEF benefit package will be revised more thoroughly in Phase 2 in
harmonization with the benefit package under the NSSF as envisioned in the Universal Health Coverage (UHC) Roadmap.
Component 2: Strengthening Quality and Capacity of Health Service Delivery (US$183.3 million, of which US$116.0
million from the RGC)
7. This component supports the rollout of the National Quality Enhancement Monitoring Tools Phase 2 (NQEMTs-
II), rollout of the NCD services at a national scale, and building of service capacity of referral hospitals (RHs). To date,
three rounds of NQEMTs-II implementation have been completed to inform the performance-based Service Delivery Grant
allocated to each health facility (HF). After round 1 external assessment, the Quality Assurance Office (QAO) provided
support to hospitals in developing a quality improvement plan focusing on three standards (quality improvement, patient
safety, and client satisfaction survey), which can be implemented without requiring financial resources. The QAO has also
developed the master template for policy and procedure and will provide training on development of the tools to hospitals
and ODs in Quarter 4 of 2024. The preparation for the national rollout of NCD services is being finalized. The screening for
diabetes, hypertension, and cervical cancer already started in some health centers (HCs). As of the progress review on
August 20, 2024, the MOH decided to roll out the Service Delivery Grant linked to screening services in 5 provinces first
from October 1, 2024. The national rollout will be discussed during the midterm review (MTR) scheduled for June 2025,
considering the experience in the 5 provinces. The MOH has also finalized a draft Health Infrastructure Investment Plan
to inform decision on infrastructure support under the project.
Component 3: Project Management, M&E, GESI (US$3.7 million)
8. While there have been some improvements in managing the implementation of certain technical areas, the
progress of procurement has been very slow, severely affecting the project implementation. HEF claims for February
and March 2024 were paid with a delay. However, the payment for HEF claim from April 2024 is on track. To expedite the
project implementation, the project management team pays close attention to monitoring and supporting technical
departments to actively implement project activities toward achieving targets for Years 1 and 2. The procurement of all
packages as defined in the negotiated 18-month Procurement Plan need to be executed by the end of December 2024,
4 As of November 20, 2024.
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
and the Department of Budget and Finance (DBF) monitors expenditures against fund availability and processes
withdrawal applications in a timely manner to prevent future shortages of funds for HFs. Coordination among the technical
departments is one of the key challenges which the project is facing. Therefore, the project is recruiting two consultants
to support the coordination of the project implementation in technical, administration, and finance to enhance the project
implementation performance. The consultants are expected to be on board in early January 2025.
9. The Gender Mainstreaming Action Group (GMAG) made some progress on GESI activities, including finalizing
the GMAG capacity assessment tool at the national level and transferring the finalized questionnaire to the online
platform. Membership of GMAG at the subnational level has been established. GMAG has faced challenges in
implementing the action plan for GESI included in the Annual Work Plan and Budget 2023 due to the ambitious plan at
design and lack of capacity and bandwidth among GMAG members. After significant delays, the GESI technical consultant
for the GMAG Secretariat has been hired (from August 15, 2024). The launch of GMAG capacity assessment at the national
and subnational level has received clearance from the Minister of Health. Data collection was completed in October, and
the GMAG team conducted consultative workshop on the preliminary findings on November 11-12, 2024. During the
technical mission conducted between September 11–17, 2024, discussions were organized between GMAG, the World
Bank, and pooling partners to discuss options to simplify GESI activities in HEQIP-II going to the MTR.
10. There are no suspensions or audit issues (including outstanding audit reports) pertaining to the project, and
there are no major issues related to fiduciary, environmental and social (E&S) standards. At the last ISR (November 29,
2024), the performance rating for monitoring and evaluation was satisfactory. Financial Management (FM) was rated
moderately satisfactory. Procurement and Project Management were rated moderately unsatisfactory due to significant
delays in the execution of key procurement packages, the submission of the AWPB 2024, and GESI activities. Meanwhile,
procurement packages have either been completed or are at the bid evaluation stage; the AWPB 2024 was approved, and
the Bank has provided no objection. Moreover, the GESI activities have been implemented after the GESI consultant came
on board in August 2024.
11. A Level 2 restructuring was completed and became effective on June 25, 2024. The restructuring aimed to (a)
add the National Payment Certification Agency (NPCA) as a new implementing agency reflecting the updated mandate of
the NPCA, which was recently transferred from the MOH to be under the National Council for Social Protection of the
Ministry of Economy and Finance (MEF); (b) adjust the PBC definition, especially PBC 1, PBC 2, and PBC 5; and (c) relocate
partial funding in an amount of US$0.6 million from Subcomponent 2.2 to Subcomponent 3.1 for financing the nationwide
training for Village Health Support Groups.
C. Rationale for Additional Financing
12. The World Risk Index has ranked Cambodia as the 16th most vulnerable country (out of 181 countries) affected
by storm, floods, drought, and lack of coping and adaptive strategy. Cambodia is located in a global hotspot for emerging
infectious diseases (EIDs), zoonoses, and transboundary animal diseases (TADs). 5 TADs also affect food security and
economic development, often disproportionately affecting poor and disadvantaged people. Frequent incursions and
spread of animal diseases compromise agri-food systems, trade, and food security.
13. Cambodia has made significant progress in enhancing its national capacity to prevent, detect, and respond to
public health threats. Comparing the 2024 Joint External Evaluation (JEE) results with the 2016 results, the Government
of Cambodia made marked improvements with 7.1 percent increase in the technical areas that had demonstrated capacity
(Score 4) and 10.3 percent increase in technical areas that had developed capacities (Score 3) (JEE 2016 and JEE 2024).
5 Growing human and animal populations, intensification of agricultural and livestock production, changes in land use including deforestation, and
loss of biodiversity result in increasing overlap of people, livestock, and wildlife that create an interface for the spillover and transmission of EIDs
and zoonoses.
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14. While the 2024 JEE showed improvements in most of the JEE indicators measured, key challenges remain. They
include insufficient human resources and training for public health functions, lack of intersectoral collaboration in areas
such as antimicrobial resistance (AMR) and food safety, and a need to strengthen biosafety. While multisectoral strategies
have been established, ongoing challenges remain in promoting regular communication and information sharing between
different sectors. Strengthening existing interministerial and intersectoral working groups can further enhance capacity
for implementation of International Health Regulations.
15. The experience from the COVID-19 emergency response reveals that there is a critical need to strengthen the
country’s capacity in the area of health emergency PPR. In response to the challenges presented by the COVID-19
pandemic and to prepare for future epidemics and pandemics, the RGC, with the support of development partners, is
taking decisive steps to fortify its pandemic response capabilities. The country’s strategy emphasizes the enhancement of
surveillance systems, laboratory management, and skills of health professionals. These efforts coincide with ongoing work
to achieve UHC; strengthen primary health care; and ensure effective collaboration between the human, animal, and
environmental sector for swift detection and response to epidemic and pandemic threats.
16. The proposed AF will strengthen capacity for PPR in Cambodia by focusing on surveillance, laboratories, and
human resources. At the time of the preparation of the parent project, funding had not been earmarked for PPR so no
activities in support of the deployment were included. The proposed AF will complement ongoing support from other
development partners and strengthen technical capacities of the Department of Communicable Disease Control (DCDC)
and the National Institute of Public Health (NIPH) under the MOH. The planned activities under the AF are intended to
strengthen the health system for the PPR and are in line with the parent project’s focus on health system strengthening.
Among others, the strengthening of the surveillance and public health laboratory system will prepare Cambodia to address
more effectively the EIDs, such as Mpox, which has been declared a Public Health Emergency of International Concern by
the World Health Organization (WHO) in August 2024.
17. In November 2023, the PF provided a US$19 million grant to Cambodia to strengthen human and animal health
within the One Health framework. Of this amount, US$4.82 million was allocated to the MOH for human health activities.
On April 12, 2024, the MEF formally requested the Bank to process the grant as AF to the parent project.
II. DESCRIPTION OF ADDITIONAL FINANCING
A. Proposed Changes
18. The proposed scale-up AF entails changes in the following: (a) PDO; (b) components, activities, and costs; and
(c) Results Framework. In addition, adoption of the revised Project Operation Manual (POM) is instituted as a condition
for effectiveness. Further details are provided below.
(i) Change to the PDO
19. With the new component focusing on the PPR, the PDO will be revised to read as “The PDO is to improve
equitable utilization of quality health services, to strengthen capacity for health emergency prevention, preparedness,
and response, and to provide immediate and effective response in case of an Eligible Crisis or Emergency in the Kingdom
of Cambodia.�?
20. Dropping the words “especially for the poor and vulnerable populations�? in the new version of the PDO is not
the result of this AF but is out of the recognition that the first part of the PDO (to improve equitable utilization) already
incorporates the focus on the poor and vulnerable populations. Removing this clause will help simplify the PDO
statement, which has become more complicated with the added element on the PPR, while not losing the meaning of
focusing on the poor and vulnerable populations.
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
(ii) Change in the Components, Activities, and Costs
21. A new component will be added as Component 4 and the current Component 4 on Contingent Emergency
Response will become Component 5. Total project financing will be increased by US$4.82 million, resulting in the total
project cost of US$303.82 million. The AF will not introduce any new PBC and will not bring about any changes to the
existing PBC targets and definition.
Component 4 (new): Strengthening Capacity for Health Emergency Prevention Preparedness and Response (US$4.82
million)
22. The objective(s) of this component is to strengthen (in collaboration with the Asian Infrastructure Investment
Bank, FAO, and other development partners):
(a) Surveillance systems to better prepare Cambodia to detect, prevent, and respond to emerging disease
outbreaks of pandemic potential, underpinned by a multidisciplinary One Health approach (Subcomponent
4.1),
(b) Laboratory systems to ensure the capacity and capabilities of laboratories as an essential component of
national preparedness and response to EIDs, TADs, AMR, and identified priority diseases (Subcomponent
4.2), and
(c) Human resources/workforce knowledge, skills, and technical capacity, as a cross-cutting area between
Subcomponents 4.1 and 4.2, in epidemiology, risk assessment tools, data analysis, data sharing platforms,
multidisciplinary and evidence-informed One Health approach, health science preservice curricula, and the
assessment of preparedness and response across all sectors against the 7-1-7 framework.
23. Two technical departments of the MOH will implement the AF activities. DCDC will lead Subcomponent 4.1, and
NIPH will lead Subcomponent 4.2.
Subcomponent 4.1: Strengthening Surveillance System (US$2.71 million)
24. This subcomponent contributes to enhancing the surveillance system by: (a) strengthening early warning
surveillance functions to detect priority diseases of epidemic and pandemic potential; (b) building capacity for national
and subnational stakeholders to monitor and evaluate the timeliness and effectiveness of preparedness and response
measures by integrating the 7-1-7 metric in future after-action reviews (AARs) and/or early-action review (EAR) for
One Health outbreak investigations; (c) enhancing risk assessment capacity and function at national and subnational
levels; (d) strengthening points of entry (POEs) by updating public health emergency contingency plans for airports,
seaports, and ground crossings, and enhancing the capacity of POE officials; (e) strengthening national AMR surveillance;
(f) enhancing risk communications and infodemic management to ensure the multisectoral health workforce is equipped
to deal with multi-hazard emergencies; (g) strengthening the multisectoral workforce through the development of the
national infodemic management Standard Operating Procedure (SOP) and building capacity of the relevant health
workforce at national and subnational levels on infodemic management in Cambodia; and (h) strengthening food
emergency surveillance, outbreak investigation, and response systems.
25. This subcomponent will finance individual consultants, training and workshops, vehicles, office equipment, and
printing of IEC material and SOP to support the following key activities:
(a) Developing and training an easy-to-use data interface of the MSS and establishing an MSS group at the
subnational level to support data collection and analysis (COVID-19, indicator-based surveillance, event-
based surveillance, AMR, flu, and so on) for decision-making of all public health events and linking to
coordination structures.
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(b) Developing a Memorandum of Understanding for the One Health-Rapid Response Team (OH-RRT) between
the three ministries (MAFF, Ministry of Environment, and MOH); conducting training for the OH-RRT; and
developing/updating strategies and SOPs for the OH-RRT, including zoonotic diseases and action plan.
(c) Developing/updating strategies and SOPs for interministerial risk communication strategy for multi-hazard
emergency/pandemic response, AMR surveillance and outbreak response, multisectoral response at POEs,
vector surveillance and response at POE, guidance for the operationalization of risk-based international
travel-related measures, infodemic management, and food emergency surveillance and outbreak
investigation and responses.
(d) Conducting training of trainers (TOT) at the national and subnational levels for the POE officials and clinicians
(public and private) on avian influenza and other core vector surveillance systems and providing training on
inspection of conveyances, first aid, and web-based data reporting and analysis for the POE officials.
(e) Building the capacity of all relevant workforce groups at national and subnational levels to carry out (i)
sensitive/investigative case interviews and outbreak investigations, (ii) AAR and EAR for One Health and food
emergency outbreak investigations and responses using the 7-1-7 framework, (iii) risk assessment, (iv) risk
communications, and (v) infodemic management and simulation exercises and foodborne disease outbreaks
for early detection and effective responses.
(f) Establishing a regular M&E mechanism at the subnational level, including supervision, coaching/mentoring,
and other monitoring visits to all outbreak investigation, surveillance, and response sites, including all types
of outbreaks, AMR, foodborne, and quarantine at POEs, to ensure that they function as planned, and
(g) Establishing sustainable coordinating mechanisms to coordinate the pandemic preparedness and response
in Cambodia. These include the establishment/reactivation of a bi-Technical Working Group for Zoonoses
and a quarterly meeting of AMR multisectoral Technical Working Group involving the three sectors (human,
animal, and environment).
Subcomponent 4.2: Strengthening Laboratory System (US$2.11 million)
26. This subcomponent contributes to enhancing the laboratory system by: (a) improving laboratory infrastructure,
(b) strengthening capacity and capability to undertake laboratory-based testing and surveillance, (c) increasing
collaboration between laboratories and across other sectors, (d) implementing regulation and quality management
systems, and (e) ensuring sustained and adequate financing for equipment and consumables. Areas of focus include the
following:
(a) Establishing a decentralized quality-assured laboratory-based surveillance based on at least 10 priority core
laboratory test-pathogen combinations and quality-assured AMR testing using tier-specific testing strategies
to advance molecular and sequencing capacity. This will include the development of a real-time monitoring
dashboard to monitor the data from genomic surveillance, supporting the timely detection of infectious
pathogens circulating in Cambodia for effective containment and response.
(b) Establishing laboratory systems, including sample storage, destruction, monitoring, and reporting of
incidents, to implement existing biosecurity regulations for highly dangerous pathogens and toxins that have
the potential to pose severe threats to public health and safety.
(c) Improving workforce capacity for detection, preparedness, and response for emerging and re-emerging
diseases of epidemic potential.
(d) Improving the network of public health laboratory (NPHL) real-time communication and bidirectional
feedback loops on technical support, quality management and testing, sample referral, data analysis, and
reporting to comply with 7-1-7 (A Global Target for Early Detection and Response).
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27. This subcomponent will finance consulting firms, individual consultants, training and workshops, laboratory
equipment and supplies, and small civil works to support the following key activities:
(a) Setting up follow-up systems and designs to strengthen the capacity and capabilities of laboratories as an
essential component of national preparedness and response to EIDs, TADs, AMR, and identified priority
diseases.
(b) Developing SOPs for sample collection, packaging, transportation, testing, storage, and analyses for all
prioritized pathogens and polymerase chain reaction (PCR)-based primer synthesis and design and reviewing
the public health network guidelines after piloting activities.
(c) Supporting NIPH technical staff to participate in overseas training sessions on advanced molecular
techniques related to all prioritized pathogens and bioinformatics and attending the regional Global
Laboratory Leadership Program (GLLP) and network. With the experience from the GLLP, NIPH will develop
a training curriculum that meets the Cambodian context.
(d) Conducting training and refresher training to relevant staff at NIPH and national and subnational
laboratories, conducting preparedness exercises at regular intervals, and organizing annual workshops to
disseminate molecular and genomic surveillance to relevant stakeholders.
(e) Conducting supervision to national and regional laboratories on storage, destruction, and reporting of
incidents of highly dangerous pathogens and toxins and on the implementation of NPHL against the endorsed
guidelines.
(f) Procuring equipment, reagents, and consumables for advanced technology; procuring maintenance services
for molecular and sequencing equipment, Biosafety Level 3 facility, and renovation of virology existing
facilities to build reliable access to engineering expertise required for proper maintenance of machines; and
procuring transportation services for national and regional laboratories to refer the native samples and
isolates (prioritized pathogens) to NIPH.
(g) Procuring technical consultancies in highly specialized areas of laboratory.
Table 1. Revised Project Costing Table (US$, millions)
Component/Activities Modality IDA DFAT GFF MDTF PF RGC Total
Component 1: Improving Financial Protection
20.44 7.06 5.58 8.92 0.00 70.00 112.00
and Utilization of Health Equity Fund
Output based
Subcomponent 1.1: Financing HEF 17.04 5.88 4.65 7.43 0.00 70.00 105.00
Subcomponent 1.2: Enhancing HEF
PBC 0.49 0.17 0.13 0.21 0.00 — 1.00
Management and Utilization (DPHI)
Subcomponent 1.3: Enhancing Roles and
PBC 2.91 1.01 0.8 1.28 0.00 — 6.00
Responsibilities of NPCA
Component 2: Strengthening Quality and
32.48 11.22 8.84 14.16 0.00 116.00 182.70
Capacity of Health Service Delivery
Subcomponent 2.1: Implementing New
National Quality Enhancement Monitoring SDGs+PBC 11.60 4.00 3.14 5.06 0.00 110.00 133.80
Tools II Nation-Wide
Fixed Lumpsum grants SDGs 0.00 0.00 0.00 0.00 0.00 93.00 93.00
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Component/Activities Modality IDA DFAT GFF MDTF PF RGC Total
Performance-based SDGs SDGs 9.75 3.36 2.64 4.25 0.00 17.00 37.00
QAO PBC 1.85 0.64 0.50 0.81 0.00 0.00 3.80
Subcomponent 2.2: Building comprehensive
service provision with expanded NCD services SDGs+PBC 9.20 3.18 2.51 4.01 0.00 6.00 24.90
and strong community engagements
NCD SDG and Community engagement SDG SDGs 5.94 2.05 1.62 2.59 0.00 6.00 18.20
Management and Supervision PBC 3.26 1.13 0.89 1.42 0.00 0.00 6.70
Subcomponent 2.3: Building service capacity
for the referral hospitals including civil works, IPF 11.68 4.04 3.19 5.09 0.00 0.00 24.00
digital health, and equipment
Component 3: Project Management,
Monitoring and Evaluation (M&E), Gender 2.08 0.72 0.58 0.92 0.00 0.00 4.30
Equality and Social Inclusion (GESI)
Subcomponent 3.1: Project
IPF+PBC 1.84 0.64 0.51 0.81 0.00 0.00 3.80
Management, Capacity building & M&E
Project Management, adaptive learning &
IPF 1.55 0.54 0.43 0.68 0.00 0.00 3.20
M&E
DBF PBC 0.29 0.10 0.08 0.13 0.00 0.00 0.60
Subcomponent 3.2: Gender Equality and Social
PBC 0.24 0.08 0.07 0.11 0.00 0.00 0.50
Inclusion
Component 4: Strengthening Capacity for
4.82 4.82
Health Emergency Prevention Preparedness IPF 0.00 0.00 0.00 0.00 0.00
(+) (+)
and Response
Subcomponent 4.1: Strengthening Surveillance 2.71 2.71
IPF 0.00 0.00 0.00 0.00 0.00
System (+) (+)
Subcomponent 4.2: Strengthening Laboratory 2.11 2.11
IPF 0.00 0.00 0.00 0.00 0.00
System (+) (+)
Component 5: Contingent Emergency
0.00 0.00 0.00 0.00 0.00 0.00 0.00
Response (CERC)
Total 55.00 19.00 15.00 24.00 4.82 186.00 303.82
(+1.6%)
Note: DFAT = Department of Foreign Affairs and Trade.
(iii) Addition of effectiveness condition
28. The adoption of the revised POM by the MOH will be an effectiveness condition to ensure smooth
implementation after the AF becomes effective.
(iv) Changes in the Results Framework
29. One PDO indicator and two IRIs will be added to measure the PDO outcome for strengthening capacity for
health emergency PPR as well as the achievement and implementation progress of Component 4. With the added
component, Cambodia will contribute to the corporate scorecard indicator “Number of countries benefitting from
strengthened capacity to prevent, detect and respond to health emergencies.�?
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Table 2: Changes in the Results Framework
Current Restructured
PDO Indicator PDO Outcome PDO Indicators
[New] Strengthen capacity for health PDO 6 Percentage of After-Action Review (AAR) and/or Early-Action Review
emergency prevention, (EAR) for ONE health outbreak investigations conducted up to 7 days, notified up
preparedness, and response to 1 day, and responded to up to 7 days, using the 7-1-7 Framework.
IRIs
Component 4 Intermediate Results Indicators
[New] IRI 14 Percentage of Points of Entry staff trained on vector surveillance and
control program.
[New] IRI 15 SOP for PCR-based primer synthesis and design developed and
implemented in NPHL by the end of the third year.
B. Alignment with CPF
30. The proposed AF is closely linked to the World Bank Group’s Country Partnership Framework (CPF) for FY25–29
for Cambodia (Report No. CPF0000016). The CPF comprises three high-level outcomes (HLOs) that focus on (a)
strengthening human capital outcomes; (b) enhancing competitiveness for the creation of high-quality jobs; and (c)
achieving greater resilience, especially for vulnerable households. Governance and institutional capacity issues, priorities
for climate and development, and gender and inclusion considerations are integrated throughout the World Bank Group
program. This proposed AF falls under the first HLO on strengthening human capital outcomes and is aligned directly with
the first objective to expand access to quality health, nutrition, and water, sanitation, and hygiene services. The need to
invest in health systems to ensure the productive capabilities of the population is recognized, as is the challenge of
overcoming a legacy of limited investment in human capital and socially resilient systems.
31. The proposed AF is consistent with Cambodia’s national strategies on climate change, the country’s N ationally
Determined Contribution (NDC), its Long-Term Strategy, and the goal of the Paris Agreement to combat climate change
and accelerate the country’s transition to a climate-resilient, low-carbon sustainable mode of development. On
adaptation, the operation is expected to contribute to the achievement of Cambodia Climate Change Strategic Plan 2014–
2023, and its second strategic objective to improve health care infrastructure and capacity of health personnel to response
to diseases in the context of climate change. This proposed operation is consistent with this objective as it supports
capacity building in health emergency PPR by focusing on disease surveillance, strengthening laboratory capacity, and
training the health care workforce to adapt and respond to multi-hazard emergencies. The project is also aligned with
Cambodia’ s Updated NDC 2020 which identifies human health as one of the most vulnerable sectors to the impacts of
climate change. On mitigation, this AF does not hinder the achievement of Cambodia’s mitigation goals as laid out in
Cambodia’s NDC and the Long-Term Strategy for Carbon Neutrality. Lastly, the AF is consistent with the Country Climate
for Cambodia and Development Report as it supports one of the priority actions on building health care system resilience
and capacity.
C. Sustainability
32. Ensuring the sustainability of activities funded by the PF is key to the country’s resilience to health crises. With
the grant from the PF, the project takes a comprehensive approach that includes investing in technical skills, ensuring
adequate financing for PPR, and ensuring projects are integrated with national policies.
33. Technical and institutional capacity building. Same as the parent project, the AF will be implemented by the
MOH’s technical departments. The project prioritizes upgrading the expertise of DCDC and NIPH staff. It will provide
training to epidemiologists, laboratory specialists, and data scientists; improve risk management and communication
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governmentwide; and develop border health officers' capabilities. Laboratory training will focus on spotting disease
hotspots, countering AMR, and conducting collaborative outbreak research with the animal and environment sectors. This
investment extends to local health care workers and officials, providing them with the necessary skills to detect and
manage health threats. Finally, the project also aims to reinforce partnerships across animal and environmental health
sectors that will enable the country to swiftly respond to new and/or re-emerging infectious diseases.
34. Financial sustainability. The PF grant incorporates co-financing and co-investment strategies in the design, which
enables activities initiated as part of the project design to be sustained when the PF grant ends. The government has
committed US$13 million for PPR. Additional funds are expected from the WHO for surveillance, United Nations Children’s
Fund for community involvement, USCDC for laboratory capacity improvements, and KfW for AMR.
III. KEY RISKS
35. The overall risk to achieving the PDO with the expanded scope of AF for PPR is Substantial. While the risks and
associated mitigation measures to achieving the PDO remain largely as identified in the parent project, PPR introduces
some new risks to the project that will be mitigated to the extent possible, but residual risks remain. The risk description
and mitigation measure for such risks are summarized in the following paragraphs.
36. Institutional capacity for implementation and sustainability risks are Substantial. The AF implementation will
involve multisectoral collaboration and improvement of the countries’ surveillance system, and this requires substantial
technical capacity of NIPH and DCDC to implement the project-planned activities. The project will recruit consultants to
support the implementation and training of the technical department staff of NIPH and DCDC as well as leverage the
technical support from partners such as the WHO and FAO.
37. Fiduciary risks are Substantial primarily due to the risk identified in the parent project. The fiduciary function of
the proposed AF will be performed by the DBF for FM and the Procurement Unit of the MOH for procurement. While the
MOH’s DBF and Procurement Unit have developed the fiduciary capacity under the current World Bank-financed health
projects, the units are facing shortage of staff and increasing workloads. However, the project will recruit more consultants
to support the Procurement Unit, and training will be provided to DBF staff.
38. The environmental risk is Substantial. The risks and impacts associated with the new activities include (a)
laboratory testing/sequencing of known pathogens resulting in potential direct impacts from infectious wastes and (b)
technical assistance (TA) support to improve disease surveillance and laboratory management (and associated capacity
building) should improve management of wastes and reduce overall risk of transmission of dangerous pathogens but may
also result in downstream impacts due to increased handling of dangerous pathogen samples and resulting laboratory
wastes. Mitigation measures include ensuring that these laboratories, as well as related waste management facilities, are
operated in line with national regulations and guidelines as well as the good international industry practices (GIIP).
Additionally, TORs and outputs of TA will ensure relevant national regulations and guidelines as well as GIIP are addressed.
39. The social risk is Substantial. Risks and impacts associated with the new activities relate to occupational health
and safety (OHS) of workers in the laboratory, and potential impacts to communities, in particular with regard to
dangerous pathogens and toxins if biosecurity measures are not well implemented. Mitigation measures are
mainstreamed into the project’s activities and include ensuring that laboratories are operated in line with national
regulations and guidelines as well as GIIP.
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IV. APPRAISAL SUMMARY
A. Technical, Economic, and Financial (if applicable) Analysis
40. Pandemic preparedness and response efforts hold substantial value in both public health and economic realms.
Such proactive investments stave off the staggering expenses associated with emergency responses and shield
communities from the far-reaching impacts of health crises, ensuring the continuity of societal functions and daily
economic operations.
41. The lessons from COVID-19 have highlighted the criticality of quick adaptation in health care systems to meet
the challenges posed by rapid changes and increasing demands during a pandemic. Effective surveillance and laboratory
systems are indispensable for managing infectious disease outbreaks, particularly with the growing likelihood of zoonotic
origins.
42. The role of surveillance is indispensable in pandemic management, serving both as an early detection system
and as a guiding mechanism that collects, analyzes, and disseminates health data. This flow of information is crucial for
public health officials to rapidly adjust strategies, allocate resources efficiently, and shape informed health policies.
Surveillance also plays a vital role in linking global health networks, facilitating the rapid sharing of critical data across
international lines.
43. Cambodia’s experience has underscored the need to bolster surveillance capabilities, with a focus on enhancing
communication with frontline HFs, improving surveillance at the POE, and adhering to the 7-1-7 response guidelines for
more prompt action.
44. Laboratories, meanwhile, are essential in a pandemic, tasked with identifying and studying pathogens. Their
work is foundational in shaping public health responses, developing vaccines and treatments, and forming the scientific
basis for policy decisions. Integral to laboratory operations is the concept of biosafety, ensuring the protection of
laboratory personnel and the environment from exposure to harmful biological agents, particularly as laboratories take
on more complex roles and increased workloads.
45. Capacity building, with an emphasis on human resources in surveillance and laboratory operations is imperative
for effective pandemic prevention and management. Training a skilled workforce in epidemiology and laboratory
sciences empowers nations to enhance their disease monitoring and response systems. This includes developing
specialized biosafety skills essential for the protection of laboratory staff and the public.
46. Investing in pandemic preparedness has been shown to be highly cost-effective. A team at the Jameel Institute,
Imperial College London estimates that investments in pandemic preparedness, on average, may avert between 49 and
124 per 100,000 population, depending on the country. In the United States, where data are available, it was estimated
that should a COVID-19-like pandemic strike in the next decade, for every dollar spent on pandemic preparedness, the
expected health gain in averted deaths would be US$1,703 and the expected economic gain in averted gross domestic
product loss would be US$1,102 (Center for Global Development 2021). Such investments are particularly vital for
protecting the most vulnerable populations in societies that may lack comprehensive health coverage, potentially averting
the significant costs and social impacts linked with widespread infection. In resource-constrained settings, the
repercussions of pandemics are profound, as seen with diseases such as COVID-19, severe acute respiratory syndrome, or
avian influenza, which can overburden health care systems and disrupt essential services for chronic conditions, mental
health, and substance use disorders.
47. Evidence to date underscores the necessity of investing in PPR as a means to mitigate the economic and social
impacts of pandemics, upholding societal norms, and ensuring economic functionality amid health crises. In Cambodia
specifically, the economic toll of COVID-19 has been notable, with the economy contracting by 3.1 percent in 2020,
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marking a significant downturn from the steady 7 percent annual growth recorded from 2010 to 2019. This contraction
was largely due to the health management measures implemented, such as business and school closures and lockdown
measures, which drastically affected key industries such as tourism and manufacturing.
48. The project activities are considered to be aligned with the goals of the Paris Agreement on both mitigation and
adaptation.
• Assessment and reduction of mitigation risks. Activities financed to strengthen the disease surveillance and
laboratory system involving purchasing laboratory equipment and instruments, capacity building of health
care providers and upgrading information and communication technology (ICT) and digital technologies for
health systems are considered universally aligned (the operation does not finance any physical infrastructure
including data centers). Minor renovation will include partitioning and repainting a 20-square-meter
room/laboratory in a grid-connected, fully electrified existing facility and hence can be categorized as low
risk.6 The project will adopt low-carbon procurement practices to reduce greenhouse gas emissions including
procurement of energy-efficient equipment for laboratories following IEC, EnergyStar, and similar relevant
energy efficiency standards in line with NDC and Long Term Strategy for Low Carbon and Climate Resilience
objectives. Thus, the operation is considered aligned with the Paris Agreement.
• Assessment and reduction of adaptation risks. Cambodia is exposed to extreme weather events such as
intense rain, flooding, and extreme heat, which disrupt the provision of health care services by making many
areas unreachable. The parent project has been screened for short and long-term climate change and disaster
risks, with the risk for project implementation identified as ‘Moderate,’ and the risk to the population served
by the project identified as ‘Substantial.’ The AF activities build upon the parent project without significant
modifications in scope and therefore the climate change risk assessment remain applicable for this operation.
However, the inclusion of risk reduction measures in the project design limits the exposure to a low level of
residual risk. These strategies involve procuring equipment and technologies suited for the Cambodian
context, including for its climate, integrating climate considerations into operational guidelines and manuals
for laboratories and disease surveillance systems and procuring professional services for equipment
maintenance. Furthermore, the project strengthens the capacity of public health personnel, including those
in regional and national laboratories to manage disease outbreaks including EIDs and others exacerbated by
climate change. The parent project activities are also noteworthy in this context as several of those address
climate vulnerability and enhance Cambodia’s health system resilience through provision of universal health
insurance to at risk groups,7 by mainstreaming climate-informed health services at public HFs and applying
climate-resilient design in hospital renovations. Thus, risks from climate hazards have been reduced to an
acceptable level and the operation is considered aligned with the Paris Agreement.
B. Financial Management
49. There are no changes in the FM and disbursement arrangements for the proposed AF that are well aligned with
the World Bank’s requirements under the World Bank’s policy and Directive on Investment Project Financing (IPF). The
MOH’s DBF has been actively implementing a number of the World Bank-financed projects. The accounting system, the
use of accounting software and supplementary FM Manual of the parent project are all applied to the AF. The
accountability for submission of the semester unaudited interim financial reports (IFRs) covering the original IDA fund and
the AF no later than 45 days after the semester calendar-end and the external audit of the annual financial statements
covering the original IDA credit and the AF no later than six months after the end of the fiscal year remain unchanged.
6 Power backup is mainly provided by uninterruptible power supply (UPS), systems when outage is less than one hour, and the secondary source is
a generator.
7 Ethnic minorities, indigenous people, people living in remote and hard-to-reach areas and often most affected by extreme weather events.
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There is only a minor task to customize the QuickBooks to accommodate the new fund source of the AF so that the receipts
and disbursements from the AF can be tracked.
50. The AF will be channeled to the pooled Designated Account (DA) with the original IDA credit maintained by the
MOH at the National Bank of Cambodia in US dollars. The ceiling of the DA for both the original IDA and the AF is
dependent on the project’s needs and approvals by the World Bank’s Task Team Leader. The original IDA and the AF will
cofinance the project’s activities in a parallel arrangement, and the AF will finance 100 percent of the specific goods
required for the project. As the local currency, the riel, is remarkably stable and the US dollar notes are commonly used
nationwide, there is no substantial risk of fraud when conducting financial transactions. The use of IFR for documentation
of non-PBC expenditures for the original IDA fund will be also applied to the AF, and the statement of expenditure-based
disbursement will be used to document the PBC-related expenditures paid from the project’s DA.
C. Procurement
51. The project will support procurement of equipment for office and laboratory, lab supplies, vehicles, small civil
works, training, and operating cost. Procurement under the AF will be carried out in accordance with the World Bank
Procurement Regulations for IPF Borrowers, Fifth Edition September 2023 and the provisions in the Financing Agreement.
The World Bank Anti-Corruption Guidelines dated October 2006, revised January 2011, and July 1, 2016, would also apply.
National market approaches, including National Procurement and Request for Quotations will be carried out in accordance
with the Kingdom of Cambodia’s Updated Standard Operating Procedures and Procurement Manual for All Externally
Financed Projects/Programs (‘Procurement Manual’), as per Sub-Decree No. 181 ANK/BK, dated December 2, 2019,
subject to the additional provisions included in the Procurement Plan. The World Bank’s Systematic Tracking of Exchanges
in Procurement (STEP) tool will be used to prepare, clear, and update Procurement Plans and conduct all procurement
transactions for the project. The residual procurement risk remains Substantial. The MOH Procurement Unit will carry out
the procurement of the PF. The MOH remains the implementing agency for the project. The procurement activities will
be undertaken by the Procurement Unit of the MOH. Total 19 procurement packages worth US$1.33 million were defined
in the 18-month negotiated Procurement Plan, including office equipment, vehicles, consulting firms, individual
consultants, printing IEC material and SOP, and laboratory equipment and supplies.
D. Legal Operational Policies
Triggered?
Projects on International Waterways OP 7.50 No
Projects in Disputed Areas OP 7.60 No
E. Environmental & Social
52. The Environmental and Social Risk Classification (ESRC) remains at Substantial. In terms of environmental risks
and impacts, the new risk associated with the additional activities under the restructuring is laboratory
testing/sequencing of known pathogens (such as influenza) resulting in potential direct impacts from infectious wastes.
No laboratory testing/sequencing of unknown pathogens will be directly financed under the project. Risk mitigation
measures include ensuring that these laboratories, as well as related waste management facilities, are operated in line
with national regulations and guidelines as well as the good GIIP. TA support to improve disease surveillance and
laboratory management (and associated capacity building) should improve management of wastes and reduce overall risk
of transmission of dangerous pathogens but may also result in downstream impacts due to increased handling of
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dangerous pathogen samples and resulting laboratory wastes. TORs and outputs of TA will ensure relevant national
regulations and guidelines, as well as GIIP, are addressed. Social risks and impacts relate to OHS of workers in the
laboratory, and potential impacts to communities, in particular, with regard to dangerous pathogens and toxins if
biosecurity measures are not well implemented. Mitigation measures are mainstreamed into the project’s activities and
include ensuring that laboratories are operated in line with national regulations and guidelines as well as GIIP.
53. The project’s Environmental and Social Commitment Plan (ESCP), Stakeholder Engagement Plan (SEP), and
Environmental and Social Management Framework (ESMF) were updated and redisclosed on the MOH’s website8 on
July 24, 2024. These updates were made to address new risks and mitigation measures, which included the addition of a
line on TA in the ESCP. The Preventive Medicine Department (PMD), responsible for the management of E&S in the
project’s activities, has made progress in establishing an Environment and Social Safeguards Working Group, providing
information about E&S risk management in progress reports, and developing E&S training materials including infection
prevention and control/healthcare waste management. These improvements should be extended to cover the new
activities. While the PMD has hired an environmental specialist consultant, a social specialist consultant was recruited,
and the consultant was on board on July 15, 2024. PMD received the hands-on expanded implementation support (HEIS)
from the World Bank’s consultant on the ESMF. The HEIS will contribute to the improvement in the implementation of
ESMF by the PMD in particular the project’s Grievance Redress Mechanism (GRM).
F. WORLD BANK GRIEVANCE REDRESS
54. Grievance redress. Communities and individuals who believe that they are adversely affected by a project
supported by the World Bank may submit complaints to existing project-level grievance mechanisms or the Bank’s
Grievance Redress Service (GRS). The GRS ensures that complaints received are promptly reviewed in order to address
project-related concerns. Project affected communities and individuals may submit their complaint to the Bank’s
independent Accountability Mechanism (AM). The AM houses the Inspection Panel, which determines whether harm
occurred, or could occur, as a result of Bank non-compliance with its policies and procedures, and the Dispute Resolution
Service, which provides communities and borrowers with the opportunity to address complaints through dispute
resolution. Complaints may be submitted to the AM at any time after concerns have been brought directly to the attention
of Bank Management and after Management has been given an opportunity to respond. For information on how to submit
complaints to the Bank’s GRS, please visit http://www.worldbank.org/GRS. For information on how to submit complaints
to the Bank’s AM, please visit https://accountability.worldbank.org.
@#&OPS~Doctype~OPS^dynamics@afaprproposedchanges#doctemplate
Summary changes
VI. PROPOSED CHANGES
Operation Information Proposed Changes Operation Information Proposed Changes
Development Objective Yes Loan Closing Date Extension No
Summary Description
Yes Loan Cancellations No
(Operation Abstract)
Results Yes Reallocations No
Conditions Yes Financial Management No
Components Yes Procurement No
8 https://hismohcambodia.org/public/announcements.php?pid=32
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
Legal Operational Policies No Institutional Arrangement No
MFD/PCE No Implementation Schedule No
Legal Covenants No Implementation Modalities No
Implementation Modalities No
Disbursements Estimates No
Disbursements Arrangements No
Clients No
Beneficiary Countries No
@#&OPS~Doctype~OPS^dynamics@afaprdetailedchanges#doctemplate
VII. DETAILED CHANGE(S)
DEVELOPMENT OBJECTIVE (DO)
Development Objective
Development Objective (Approved as part of Approval Package on 09-Mar-2022)
The PDO is to improve equitable utilization of quality health services in Cambodia, especially for the poor and vulnerable
populations, and to provide immediate and effective response in case of an Eligible Crisis or Emergency in the Kingdom
of Cambodia.
Current Development Objective (Approved as part of Additional Financing Package Seq No 1 on 05-Dec-2024)
The PDO is to improve equitable utilization of quality health services, to strengthen capacity for health emergency
prevention, preparedness, and response, and to provide immediate and effective response in case of an Eligible Crisis or
Emergency in the Kingdom of Cambodia.
Proposed New Development Objective
Operation Abstract: Summary Description of Proposed Operation
Operation Abstract (Approved as part of Approval Package on 09-Mar-2022)
H-EQIP II will build on lessons learned from the current phase of H-EQIP to support the RGC in advancing UHC over a
five-year period (July 2022-December 2027) with continued focus on improving financial protection and the equitable
access to the health services for the poor and vulnerable, enhancing quality of health services and strengthening the
health service delivery system. it will also aim to increase the performance, sustainability, efficiency and social
inclusion focus of national institutions
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
The project will support RGC’s vision in establishing universal health insurance coverage in Cambodia through
improving the utilization of Health Equity Fund (HEF) and strengthening the capacity of Payment Certification Agency
as the claim validation agency for major health insurance schemes in Cambodia. The Project will support rolling out the
National Quality Enhancement Monitoring Tools-II (NQEMT-II) nation-wide, it will further strengthen NCDs service
provision through expanding coverage and introducing community-based and people-centered service delivery model,
and investing on referral hospitals to address the service capacity gaps to ensure the provision of essential service
package so as to increase utilization of services provided by the public health facilities as a way to reduce OOP
expenditures. Another strategic focus of the Project is to leverage the RGC’s D&D agenda through strengthening
community engagement to improve access and utilization, improving gender equality and social inclusion, and carrying
out health promotion to address risk factors of NCDs and improve community resilience to public health emergencies.
In addition, the Project will support the RGC’s national digital health strategy and build an adaptive learning agenda in
support of reform initiatives, provide constant implementation support and technical assistance to the MOH as well as
to facilitate continuous mutual learning and knowledge transfer.
The project will further strengthen the focus on results through expanding SDGs to finance more health programs
under the project as well as using performance-based conditions (PBCs) with an investment project financing (IPF).
PBCs are a set of indicators, as part of the Project result framework, aiming at measuring performance against key
actions and interventions. This performance-focused financing approach would promote timely achievements of PBC
targets. Achievement of PBC targets will be verified by a third-party independent verification team (IVT).
The proposed Project’s activities are closely linked with the World Bank Group’s Twin Goals: reduce extreme poverty
and enhance shared prosperity, the World Bank’s Health, Nutrition and Population Global Practice’s focus to assist
clients to accelerate progress toward UHC, as well as the Country Partnership Framework (CPF) for FY19-23 for
Cambodia. The CPF comprises three focus areas, and this proposed project falls under the second focus area on
fostering human development and is aligned directly with the third objective of the second focus area which is
expanding access to quality health services. The proposed project will also support aspects of the CPF’s critical cross-
cutting theme which underpins reforms in all three focus areas—strengthening governance, institutions, and citizen
engagement, and aligns with the WB Gender Equality Strategy
The PDO will be achieved by activities under four Components of H-EQIP2:
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
COMPONENT 1: Improving Financial Protection and Utilization of Health Equity Fund – The strategic objective of this
component is to support RGC’s vision of building a universal health insurance scheme in Cambodia as an important
step in achieving UHC by 2030. With co-financing from RGC, this component will continue to support HEF to: (i) cover
the cost of health services for the poor, including those most vulnerable to the impacts of climate change and natural
disasters.; (2) optimize and expand the HEF benefit package and update the reimbursement rate of HEF; (iii) support
increased utilization of HEF through addressing barriers to social awareness and inclusion and gender equality; and (iv)
expand the coverage of full PMRS to all the remaining health centers and referral hospitals. This component will also
support building financial sustainability, improving capacity and expanding functions of the PCA as the single agency to
certify claims for all health insurance schemes in Cambodia as well as to validate the public services for other sectors.
In addition, this component will also support RGC in strengthening social health protection through policy dialogue and
technical assistance, including capacity building activities.
COMPONENT 2: Strengthening the Quality and Capacity of Health Service Delivery--Building on the progress made in H-
EQIP phase I, this component will focus on strengthening the health service delivery system in Cambodia, particularly
at the subnational level (provincial/referral hospitals and health centers), with enhanced efforts on improving service
quality, expanding service capacity and coverage, shifting the service delivery model and strengthening community
based essential service provision. This will be done by implementing the National Quality Enhancement Monitoring
Tools (NQEMT) nation-wide, rolling out NCD care to all the health centers enhancing VHSG and community
engagement and building health service capacities in the referral hospitals including civil works, digital health and
equipment. It will support MOH to implement the National Digital Health Strategy 2021-2030. This component will
continue using SDGs, both fixed lump-sum grants and performance-based grants, to provide performance-based
financing to health facilities. It will also provide funds to PHDs/ODs and key MOH agencies via PBCs in building up
internal health service performance targets and promoting enhanced responsibility and accountability at sub-national
levels.
COMPONENT 3: Project Management, Monitoring & Evaluation, Gender Equality and Social Inclusion and - will finance
activities related to project implementation management, implementation of environment and social development
activities, mutual learning, financial management and procurement capacity building and monitoring & evaluation. In
addition, this component will support gender equity and community engagement. Gender inclusion will put an
emphasis on increased capacity and performance of Gender Mainstreaming Action Group (GMAG), and the project’s
support of a Women in Leadership Development program will strengthen women’s voice and participation in decision-
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
making in the sector, and leadership on Gender Equality and Social Inclusion (GESI) and health (sub-component 3.2:
Gender and Social Inclusion.
COMPONENT 4: Contingency Emergency Response (CERC) -The objective of the contingent emergency response
component (CERC), with a provisional zero allocation, is to allow for the reallocation of financing to provide an
immediate response to an eligible crisis or emergency as needed.
Current Operation Abstract (Approved as part of Additional Financing Package Seq No 1 on 04-Dec-2024)
H-EQIP II will build on lessons learned from the current phase of H-EQIP to support the Royal Government of Cambodia
(RGC) in advancing Universal Health Coverage (UHC) over a five-year period (July 2022-December 2027) with continued
focus on improving financial protection and the equitable access to the health services for the poor and vulnerable,
enhancing quality of health services, strengthening the health service delivery system and strengthening capacity for
health emergency prevention, preparedness, and response. It will also aim to increase the performance, sustainability,
efficiency, and social inclusion focus of national institutions. The project will support RGC’s vision in establishing
universal health insurance coverage in Cambodia through improving the utilization of Health Equity Fund (HEF) and
strengthening the capacity of National Payment Certification Agency (NPCA) as the claim validation agency for major
health insurance schemes in Cambodia. The Project will support rolling out the National Quality Enhancement
Monitoring Tools-II (NQEMT-II) nation-wide, and it will further strengthen Non Communicable Diseases (NCDs) service
provision through expanding coverage and introducing community-based and people-centered service delivery model,
and investing on referral hospitals (RHs) to address the service capacity gaps to ensure the provision of essential
service package so as to increase utilization of services provided by the public health facilities as a way to reduce Out
Of Pocket expenditures. Another strategic focus of the Project is to leverage the RGC’s D&D agenda through
strengthening community engagement to improve access and utilization, improving gender equality and social
inclusion, and carrying out health promotion to address risk factors of NCDs and improve community resilience to
public health emergencies. In addition, the Project will support the RGC’s national digital health strategy and build an
adaptive learning agenda in support of reform initiatives, provide constant implementation support and technical
assistance to the Ministry of Health (MOH) as well as to facilitate continuous mutual learning and knowledge transfer.
The project will further strengthen the focus on results through expanding SDGs to finance more health programs
under the project as well as using performance-based conditions (PBCs) with an investment project financing. PBCs are
a set of indicators, as part of the Project result framework, aiming at measuring performance against key actions and
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
interventions. This performance-focused financing approach would promote timely achievements of PBC targets.
Achievement of PBC targets will be verified by a third-party independent validation team (IVT).
The proposed Project’s activities are closely linked with the World Bank Group’s Twin Goals: reduce extreme poverty
and enhance shared prosperity, the World Bank’s Health, Nutrition and Population Global Practice’s focus to assist
clients to accelerate progress toward UHC, as well as the Country Partnership Framework (CPF) for FY19-23 for
Cambodia. The CPF comprises three focus areas, and this proposed project falls under the second focus area on
fostering human development and is aligned directly with the third objective of the second focus area which is
expanding access to quality health services. The proposed project will also support aspects of the CPF’s critical cross-
cutting theme which underpins reforms in all three focus areas—strengthening governance, institutions, and citizen
engagement, and aligns with the WB Gender Equality Strategy.
The PDO will be achieved by activities under five Components of H-EQIP II:
COMPONENT 1: Improving Financial Protection and Utilization of HEF – The strategic objective of this component is to
support RGC’s vision of building a universal health insurance scheme in Cambodia as an important step in achieving
UHC by 2030. With co-financing from RGC, this component will continue to support HEF to: (i) cover the cost of health
services for the poor, including those most vulnerable to the impacts of climate change and natural disasters.; (2)
optimize and expand the HEF benefit package and update the reimbursement rate of HEF; (iii) support increased
utilization of HEF through addressing barriers to social awareness and inclusion and gender equality; and (iv) expand
the coverage of full Patient Management Registration System to all the remaining health centers (HCs) and RHs. This
component will also support building financial sustainability, improving capacity and expanding functions of the NPCA
as the single agency to certify claims for all health insurance schemes in Cambodia. In addition, this component will
also support RGC in strengthening social health protection through policy dialogue and technical assistance, including
capacity building activities.
COMPONENT 2: Strengthening the Quality and Capacity of Health Service Delivery – Building on the progress made in
H-EQIP phase I, this component will focus on strengthening the health service delivery system in Cambodia, particularly
at the subnational level (provincial/referral hospitals and HCs), with enhanced efforts on improving service quality,
expanding service capacity and coverage, shifting the service delivery model and strengthening community based
essential service provision. This will be done by implementing the NQEMT-II nation-wide, rolling out NCD care to all the
Page 19
The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
HCs enhancing Village Health Support Group and community engagement and building health service capacities in the
RHs including civil works, digital health and equipment. It will support MOH to implement the National Digital Health
Strategy 2021-2030. This component will continue using SDGs, both fixed lump-sum grants and performance-based
grants, to provide performance-based financing to health facilities. It will also provide funds to PHDs/ODs and key
MOH agencies via PBCs in building up internal health service performance targets and promoting enhanced
responsibility and accountability at sub-national levels.
COMPONENT 3: Project Management, Monitoring & Evaluation, Gender Equality and Social Inclusion (GESI) and - will
finance activities related to project implementation management, implementation of environment and social
safeguard activities, mutual learning, financial management and procurement capacity building and monitoring &
evaluation. In addition, this component will support gender equity and community engagement. Gender inclusion will
put an emphasis on increased capacity and performance of Gender Mainstreaming Action Group, and the project’s
support of a Women in Leadership Development program will strengthen women’s voice and participation in decision-
making in the sector, and leadership on GESI and health.
Component 4: Strengthening Capacity for Health Emergency Prevention Preparedness and Response and will strength
capacity for PPR in Cambodia by focusing on surveillance, laboratories, and human resources.
COMPONENT 5: Contingency Emergency Response (CERC) -The objective of the CERC, with a provisional zero
allocation, is to allow for the reallocation of financing to provide an immediate response to an eligible crisis or
emergency as needed.
Proposed Operation Abstract
H-EQIP II will build on lessons learned from the current phase of H-EQIP to support the Royal Government of Cambodia
(RGC) in advancing Universal Health Coverage (UHC) over a five-year period (July 2022-December 2027) with continued
focus on improving financial protection and the equitable access to the health services for the poor and vulnerable,
enhancing quality of health services, strengthening the health service delivery system and strengthening capacity for
health emergency prevention, preparedness, and response. It will also aim to increase the performance, sustainability,
efficiency, and social inclusion focus of national institutions. The project will support RGC’s vision in establishing
universal health insurance coverage in Cambodia through improving the utilization of Health Equity Fund (HEF) and
strengthening the capacity of National Payment Certification Agency (NPCA) as the claim validation agency for major
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
health insurance schemes in Cambodia. The Project will support rolling out the National Quality Enhancement
Monitoring Tools-II (NQEMT-II) nation-wide, and it will further strengthen Non Communicable Diseases (NCDs) service
provision through expanding coverage and introducing community-based and people-centered service delivery model,
and investing on referral hospitals (RHs) to address the service capacity gaps to ensure the provision of essential
service package so as to increase utilization of services provided by the public health facilities as a way to reduce Out
Of Pocket expenditures. Another strategic focus of the Project is to leverage the RGC’s D&D agenda through
strengthening community engagement to improve access and utilization, improving gender equality and social
inclusion, and carrying out health promotion to address risk factors of NCDs and improve community resilience to
public health emergencies. In addition, the Project will support the RGC’s national digital health strategy and build an
adaptive learning agenda in support of reform initiatives, provide constant implementation support and technical
assistance to the Ministry of Health (MOH) as well as to facilitate continuous mutual learning and knowledge transfer.
The project will further strengthen the focus on results through expanding SDGs to finance more health programs
under the project as well as using performance-based conditions (PBCs) with an investment project financing. PBCs are
a set of indicators, as part of the Project result framework, aiming at measuring performance against key actions and
interventions. This performance-focused financing approach would promote timely achievements of PBC targets.
Achievement of PBC targets will be verified by a third-party independent validation team (IVT).
The proposed Project’s activities are closely linked with the World Bank Group’s Twin Goals: reduce extreme poverty
and enhance shared prosperity, the World Bank’s Health, Nutrition and Population Global Practice’s focus to assist
clients to accelerate progress toward UHC, as well as the Country Partnership Framework (CPF) for FY19-23 for
Cambodia. The CPF comprises three focus areas, and this proposed project falls under the second focus area on
fostering human development and is aligned directly with the third objective of the second focus area which is
expanding access to quality health services. The proposed project will also support aspects of the CPF’s critical cross-
cutting theme which underpins reforms in all three focus areas—strengthening governance, institutions, and citizen
engagement, and aligns with the WB Gender Equality Strategy.
The PDO will be achieved by activities under five Components of H-EQIP II:
COMPONENT 1: Improving Financial Protection and Utilization of HEF – The strategic objective of this component is to
support RGC’s vision of building a universal health insurance scheme in Cambodia as an important step in achieving
Page 21
The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
UHC by 2030. With co-financing from RGC, this component will continue to support HEF to: (i) cover the cost of health
services for the poor, including those most vulnerable to the impacts of climate change and natural disasters.; (2)
optimize and expand the HEF benefit package and update the reimbursement rate of HEF; (iii) support increased
utilization of HEF through addressing barriers to social awareness and inclusion and gender equality; and (iv) expand
the coverage of full Patient Management Registration System to all the remaining health centers (HCs) and RHs. This
component will also support building financial sustainability, improving capacity and expanding functions of the NPCA
as the single agency to certify claims for all health insurance schemes in Cambodia. In addition, this component will
also support RGC in strengthening social health protection through policy dialogue and technical assistance, including
capacity building activities.
COMPONENT 2: Strengthening the Quality and Capacity of Health Service Delivery – Building on the progress made in
H-EQIP phase I, this component will focus on strengthening the health service delivery system in Cambodia, particularly
at the subnational level (provincial/referral hospitals and HCs), with enhanced efforts on improving service quality,
expanding service capacity and coverage, shifting the service delivery model and strengthening community based
essential service provision. This will be done by implementing the NQEMT-II nation-wide, rolling out NCD care to all the
HCs enhancing Village Health Support Group and community engagement and building health service capacities in the
RHs including civil works, digital health and equipment. It will support MOH to implement the National Digital Health
Strategy 2021-2030. This component will continue using SDGs, both fixed lump-sum grants and performance-based
grants, to provide performance-based financing to health facilities. It will also provide funds to PHDs/ODs and key
MOH agencies via PBCs in building up internal health service performance targets and promoting enhanced
responsibility and accountability at sub-national levels.
COMPONENT 3: Project Management, Monitoring & Evaluation, Gender Equality and Social Inclusion (GESI) and - will
finance activities related to project implementation management, implementation of environment and social
safeguard activities, mutual learning, financial management and procurement capacity building and monitoring &
evaluation. In addition, this component will support gender equity and community engagement. Gender inclusion will
put an emphasis on increased capacity and performance of Gender Mainstreaming Action Group, and the project’s
support of a Women in Leadership Development program will strengthen women’s voice and participation in decision-
making in the sector, and leadership on GESI and health.
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
Component 4: Strengthening Capacity for Health Emergency Prevention Preparedness and Response and will strength
capacity for PPR in Cambodia by focusing on surveillance, laboratories, and human resources.
COMPONENT 5: Contingency Emergency Response (CERC) -The objective of the CERC, with a provisional zero
allocation, is to allow for the reallocation of financing to provide an immediate response to an eligible crisis or
emergency as needed.
COMPONENTS
Last Approved Proposed
Component Name Cost (USD) Action Component Name Cost (USD)
Component 1: Improving Component 1: Improving
Financial Protection and Financial Protection and
112,000,000.00 No Change 112,000,000.00
Utilization of Health Equity Utilization of Health Equity
Fund Fund
Component 2:
Component 2: Strengthening
Strengthening Quality and
182,700,000.00 No Change Quality and Capacity of 182,700,000.00
Capacity of Health Service
Health Service Delivery
Delivery
Component 3: Project Component 3: Project
Management, Monitoring & Management, Monitoring &
4,300,000.00 No Change 4,300,000.00
Evaluation, Gender Equality Evaluation, Gender Equality
and Social Inclusion and Social Inclusion
Component 4:
Component 4: Strengthening
Strengthening Capacity for
Capacity for Health
Health Emergency 4,821,650.00 No Change 4,821,650.00
Emergency Prevention
Prevention Preparedness
Preparedness and Response
and Response
Component 5: Contingent Component 5: Contingent
0.00 No Change 0.00
Emergency Response Emergency Response
TOTAL 303,821,650.00 303,821,650.00
COSTS & FINANCING
Private Capital Facilitation
Is this an MFD-Enabling Project (MFD-EP)?
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
Is this project Private Capital Enabling (PCE)?
ENVIRONMENTAL & SOCIAL
Overview
Operation Location
Operation location and salient physical characteristics relevant to the ESS Assessment (geographic, environmental,
social) (if known)
The proposed project is nationwide throughout Cambodia’s 25 provinces and is an additional component to the existing
Health Equity and Quality Improvement Project – Phase 2 (HEQIP-2) which is built on the previous H-EQIP. There are
1,374 public health facilities in Cambodia in 2020, including 8 national, 25 provincial and 91 referral hospitals, 1,182
health centers (without beds), 68 health centers (with beds), and 98 health posts. These facilities are classified based
on the level of standard service package they provide. The health centers provide primary care services (minimum
package of activities - MPA) and referral hospitals provide second-line health services (complementary package of
activities - CPA). The CPA is classified into three categories, namely CPA-1, CPA-2 and CPA-3, based on the number and
composition of staff, number of beds, standard drug kit, standard medical equipment, and clinical activities performed.
The suboptimal service capacity in the CPA hospitals, including infrastructure, equipment and health workforce, has
resulted in patients’ increasingly seeking care in the private sector, leading to high out-of-pocket health expenses.
Additional Financing (AF) to HEQIP II will incorporate a new grant awarded to Cambodia from the Pandemic Fund (PF)
for health emergency preparedness, prevention and response.
Detailed operation location(s) and salient physical characteristics relevant to the ESS Assessment (geographic,
environmental, social)
In the last decades, Cambodia has made dramatic progress in reducing poverty, but 13.5 % of the population still live
below the national poverty line and an additional 25% remain vulnerable to small economic shocks, especially in the
unprecedented context of the COVID-19 pandemic. About 90% Cambodia’s poor live in rural villages where access to
services is still lacking. There are persisting inequalities in health outcomes by socioeconomic status and between urban
and rural populations. The ID Poor program, launched in 2007, identifies poor households and provides them with
support to access health services and, more recently, to access the government cash transfer program during the
COVID-19 pandemic. Households with ID Poor cards are eligible for free health care and reimbursement of costs under
the Health Equity Fund (HEF). The proposed project is nationwide throughout Cambodia’s 25 provinces and is an
additional component to the existing Health Equity and Quality Improvement Project – Phase 2 (HEQIP-2) which is built
on the previous H-EQIP. There are 1,374 public health facilities in Cambodia in 2020, including 8 national, 25 provincial
and 91 referral hospitals, 1,182 health centers (without beds), 68 health centers (with beds), and 98 health posts. These
facilities are classified based on the level of standard service package they provide. The health centers provide primary
care services (minimum package of activities - MPA) and referral hospitals provide second-line health services
(complementary package of activities - CPA). The CPA is classified into three categories, namely CPA-1, CPA-2 and CPA-
3, based on the number and composition of staff, number of beds, standard drug kit, standard medical equipment, and
clinical activities performed. The suboptimal service capacity in the CPA hospitals, including infrastructure, equipment
and health workforce, has resulted in patients’ increasingly seeking care in the private sector, leading to high out-of-
pocket health expenses. Additional Financing (AF) to HEQIP II will incorporate a new grant awarded to Cambodia from
the Pandemic Fund (PF) for health emergency preparedness, prevention and response (PPR). Under the AF, the project
will finance activities associated with strengthening the surveillance system and laboratory management system. There
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
will be no greenfield nor civil works (aside from minor non-civil works renovation such as repainting) conducted as part
of the additional activities. The project and AF will be implemented across the country – in big cities, medium-sized
urban areas, as well as in many big and small villages and sometimes remote locations, including areas where
indigenous peoples may live. With a population of approximately 16.7 million in 2020, it is estimated that 97 % of
Cambodians are Khmer ethnicity. The remaining 3 % is composed of Cham, Vietnamese, and Chinese ethnicities and
approximately 1.25 % are divided between twenty-two indigenous ethnic minority groups. Indigenous Peoples tend to
live in the most remote areas, particularly in Ratanakiri, Mondulkiri, and Stueng Treng provinces. Gender-Based
Violence remains a serious issue in Cambodia. Distance and travel time to health facilities increase the difficulty for
women to seek care, while gender norms contribute to widespread tolerance and acceptability of GBV and reduces
women’s willingness to seek help. There is also a gender gap in trained health professionals: only 35% of nurses are
female, and female specialist doctors do not exist in training institutions. While these are the case, efforts to address
GBV issues have been on the development agenda of the government. A Steering Committee on Violence Against
Women and Violence Against Children has been established, In Cambodia’s health sector, protocols to respond to
survivors of GBV have been established, and there is a code of conduct for health service providers. Non-communicable
diseases (NCDs) account for a large and increasing share of the burden of disease in Cambodia – deaths due to NCDs
increased from 33% in 2000 to 64% in 2018. Cambodia’s poor working conditions of construction workers, including
their occupational health safety, is an ongoing issue. Many construction workers do not have access to PPEs and work
in unsafe environments. The boom of construction before the pandemic has led migrant workers to seek construction
work across the country. These increased demands in the sector have forced some young adults, including children
under 18, to quit their education and work in the brick kilns industry, including as indentured labor, which could be an
issue in the supply chain. Cambodia is located in a global hotspot for Emerging Infectious Diseases (EDIs), zoonoses, and
transboundary animal diseases (TADs). Growing human and animal populations, intensification of agricultural and
livestock production, changes in land use including deforestation, and loss of biodiversity result in increasing overlap of
people, livestock, and wildlife that create an interface for the spillover and transmission of EIDs and zoonoses (animal
diseases that can be transmitted to humans). TADs also affect food security and economic development, often
disproportionately impacting poor and disadvantaged people. Frequent incursions and spread of animal diseases
compromise agri-food systems, trade, and food security.
Borrower’s Institutional Capacity
The Ministry of Health (MOH) is responsible for implementation of the project, including the Additional Financing. The
parent project is the seventh World Bank financed health sector project in Cambodia. MOH has experience in
implementing the World Bank’s Safeguards Policies in various projects, as well as more recently has developed
experience in implementing the WB’s Environmental and Social Framework (ESF) in the parent project, the Pre-Service
Training for Health Workers Project and the COVID-19 Emergency Response Project (ERP). The National Payment
Certification Agency (NPCA) is now also an Implementing Agency on the project. Although they have experience
supporting activities under the project previously as part of MOH, the responsibilities associated with becoming an
Implementing Agency (including responsibility for E&S) are new to NPCA. The environmental and social risks associated
with their responsible activities are low; however, they will need support to develop capacity to implement the ESCP
and ESMF, where relevant. MOH is supported by two of its technical departments: Department of Hospital Service
(DHS) and Preventative Medicine Department (PMD). Both Departments are responsible for the implementation of the
relevant Environmental and Social Standards (ESSs). The DHS is responsible for health care waste management
(HCWM) and has issued the relevant national guidelines on HCWM and infection prevention and control guidelines. The
DHS is also responsible for providing training to national and sub-national level institutions and building their capacity
to implement these guidelines. However, the overall HCWM practices in Cambodia are less than satisfactory and
require more support for further improvement. Capacity for HCWM, particularly at district hospitals and health centers
remain weak. They require technical and budget support to improve their current practices on segregation, collection,
storage, treatment and disposal of infectious wastes and in restoring the operation and maintenance of incinerators.
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
The existing institutional arrangement, which relies on MOH (and more recently NPCA) for implementation, will remain
the same as the parent project; however, two technical institutions under MOH will be included in the project -
Communicable Disease Control Department (MOH-CDC) and National Institute for Public Health (NIPH) to lead sub-
component 4.1 and sub-component 4.2, respectively. Given that DHS and PMD need to simultaneously handle multiple
nationwide projects in addition to other core responsibilities assigned by the Ministry, timely implementation and
effective monitoring of ESF instruments remain a challenge. This is due to their lack of resources including staffing,
finance, and coordination. The current rating for E&S for the parent project is Moderately Satisfactory. The PMD has
made progress in establishing an Environmental and Social Safeguard Working Group (ESSWG), providing information
about E&S risk management in progress reports, and developing E&S training materials for Infection Prevention and
Control/Waste Management. While PMD has hired an environmental specialist consultant, a social specialist is yet to
be hired. Additional work is required to assign Grievance Redress Mechanism (GRM) focal points across health facilities
to ensure proper reporting on project-related grievances.
Assessment
Environmental & Social Risk Classification
Environmental Risk Rating Social Risk Rating
Substantial Substantial
Original Environmental and Social Risk Rating (ESRC) Revised Environmental and Social Risk Rating (ESRC)
Substantial Substantial
Environmental & Social Standards
E & S Standards Relevance
ESS 1: Assessment and Management of Environmental and Social Risks and
Relevant
Impacts
ESS 10: Stakeholder Engagement and Information Disclosure Relevant
ESS 2: Labor and Working Conditions Relevant
ESS 3: Resource Efficiency and Pollution Prevention and Management Relevant
ESS 4: Community Health and Safety Relevant
ESS 5: Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Relevant
ESS 6: Biodiversity Conservation and Sustainable Management of Living Natural
Not Currently Relevant
Resources
ESS 7: Indigenous Peoples/Sub-Saharan African Historically Underserved
Relevant
Traditional Local Communities
ESS 8: Cultural Heritage Not Currently Relevant
ESS 9: Financial Intermediaries Not Currently Relevant
Summary of Assessment of Environmental and Social Risks and Impacts
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Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
The overall environmental and social risk is classified as “Substantial�? and this remains unchanged with the Additional
Financing activities. The proposed Project aims to to improve equitable utilization of quality health services, to
strengthen capacity for health emergency prevention, preparedness, and response, and to provide immediate and
effective response in case of an Eligible Crisis or Emergency in the Kingdom of Cambodia. Towards this aim, the
Project will enhance access to quality health services and financial protection for the poor and vulnerable, through,
among other measures, support for scaling up Health Equity Fund (HEF) by financing health facilities nationwide. The
project will cover all public national, all provincial and referral hospitals and all health centers. The nationwide scope
of the Project means that the Project also supports health facilities located in north-eastern provinces of Cambodia,
where there is high concentration of Indigenous Peoples, who have experienced marginalized access to public
services, including health services. In addition to health services enhancement and expansion for the poor and the
vulnerable, the proposed Project will support upgrading referral hospitals, including renovation or construction of
additional hospital wards and upgrading of blood depots/banks at the provincial and regional hospitals; National
Blood Transfusion Center; and supply of sufficient drugs, medical and laboratory equipment. Under the Additional
Financing, the project will incorporate a new grant awarded to Cambodia from the Pandemic Fund (PF) for health
emergency preparedness, prevention and response (PPR). The activities under the AF are associated with
strengthening the surveillance system and laboratory management system. There will be no greenfield nor civil works
(aside from minor non-civil works renovation such as repainting) conducted as part of the additional activities. Seven
of the ten Bank’s environmental and social standards (ESS) have been screened as relevant. ESS6 on Biodiversity
Conservation and Sustainable Management of Living Natural Resources; ESS8 on Cultural Heritage , and Standard
ESS9 on Financial Intermediaries are considered not relevant. The social risk is classified as Substantial. Potential
social risks associated with the proposed project include possible exclusions of key groups, who are considered
vulnerable and marginalized, including vulnerable women who are victims of gender-based violence, the poor, people
with disabilities, Indigenous Peoples, whose access to health services is already constrained due to social, economic,
cultural and environmental barriers (i.e. language, culture, distance). It is of vital importance that vulnerable groups
have access to project benefits, and that they are able to make use of the benefits of the Project activities. Therefore,
robust stakeholder engagement is essential. Other potential social risks are tied to construction/upgrading of health
facilities, which may result in risks associated with labor management, including use of child labor in construction and
indentured labor in the supply of construction materials, safety of workers, and the spread of Covid-19 in the
community. There are also potential risks related to community health and safety due to poor waste management by
health facilities, and risks related to Gender-Based Violence (GBV) and Violence against Children (VAC) due to influx of
labor from construction activities. While project activities are expected to be confined to existing health facilities,
there could be a risk of land acquisition impacts. Capacity and commitment of MOH needs to be strengthened for
successful management of risks and impacts. The social risks and impacts for new activities under the AF relate to
risks on Occupational Health and Safety (OHS) of workers in the laboratory, and potential community health and
safety risks to communities, in particular with regards to dangerous pathogens and toxins if biosecurity and waste
management measures are not well implemented. While these activities are considered to pose a Moderate risk, the
social risk for the Project remains classified as ‘Substantial’, taking into account experience in the parent project and
MOH’s capacity on the management of the risks. The environmental risk remains unchanged at Substantial after the
addition of AF activities. The potential environmental risks, covering the overall project and including the AF, are
related to: (1) construction related risks and impacts, procurement of medical supplies and operation of health care
facilities and laboratories; and (2) client’s capacity to manage E&S risks to meet ESF requirements. Potential
environmental impacts and risks are related to construction works and the operation of hospitals, blood depots and
laboratories, with particular focus on sample management and waste generation and management. Construction-
related impacts may include traffic related accident, dust, noise, vibration, air emissions, generation of construction
wastes, and potential asbestos containing material (ACM) that may be present at facilities undergoing rehabilitation.
These impacts are temporary, predictable, reversible, and mitigatory measures are readily available and reliable.
Potential impacts will be managed through the application of good engineering designs and practices for construction
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
by incorporating environmental mitigation measures in the technical design and tender documents. The project may
also induce disposal of old medical equipment and/or supplies from refurbishment of health care facilities. Project
supported rehabilitation activities will be required to dispose of such waste, including ACM, in a technically sound
manner, depending on the type of equipment etc. Greenfield constructions are not expected as all works will be
conducted within the footprint of existing facilities. Construction of additional hospital wards will be located within
the existing hospital perimeter. TA support under the AF to improve disease surveillance and laboratory management
(and associated capacity building) should improve management of wastes and reduce overall risk of transmission of
dangerous pathogens but may also result in downstream impacts due to increased handling of dangerous pathogen
samples and resulting laboratory wastes. The operation of hospitals, blood depots, and laboratories are likely to
generate large volumes of hazardous and infectious HCWs, including COVID-19 related wastes, and non-hazardous
sanitary liquid and solid wastes. These potential environmental and health risks are well-defined and can be readily
addressed through implementation of the WBG’s Environmental, Health and Safety (EHS) Guidelines and the existing
comprehensive guidelines on Health Care Waste Management (HCWM) and infection prevention and control
prepared by MOH. The Guidelines incorporate best HCWM practices and are intended for practical application at
HCFs with limited available financial and technical resources. However, gaps exist in implementation at the referral
hospital levels. This includes an uneven application of the guidelines and insufficient resources and capacity to
properly handle and dispose of healthcare wastes. In addition, under the ongoing H-EQIP, selected HCFs have their
own waste incineration facilities installed onsite. Due diligence of existing incinerators will be conducted to examine
its technical adequacy, process capacity, performance record, and operators’ capacity. In case any gaps are
discovered, corrective measures should be recommended. MOH has developed experience with implementing World
Bank-financed project requirements regarding safeguards policies. The current rating of environmental safeguard
compliance for H-EQIP is moderately satisfactory. However, capacity to manage impacts and risks consistent with the
relevant ESSs is still limited. Also, even though MOH has sufficient policy, regulations and guidelines on HCWM, the
compliance at referral hospitals and healthcare centers remains weak. MOH has prepared and updated an ESMF
which builds on lessons learnt from the past and ongoing H-EQIP and COVID-19 ERP projects and lays out an effective
and practical process, and implementation arrangements, including the budget requirements, measures and plans to
mitigate the potential environmental risks and impacts at the individual facility level. As well as the ESMF, the ESCP
and SEP have also been updated to include the AF activities. An additional requirement on TA support has been added
to the ESCP to ensure consideration of E&S impacts (including downstream) in the ToRs of TA activities.
Last Finalized Date Is a common approach being considered?
25-Jul-2024 No
Conditions
Type Description of Conditions Action
Financing Agreement: Article V (i) The Grant Agreement
has been executed and delivered and all conditions
precedent to its effectiveness have been fulfilled; and (ii)
The Project Operational Manual has been duly adopted
by the Recipient. Grant Agreement for the grants funded
Effectiveness No Change
by Multi-Donor Trust Fund for the Global Financing
Facility in Support of Every Woman and Every Child and
Australia-World Bank Partnership for Promoting
Inclusion, Sustainability and Equality in Cambodia Single
Donor Trust Fund: Article IV (i) The execution and
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368) PROJECT PAPER
delivery of the Grant Agreement has been duly
authorized by all necessary actions and delivered on
behalf of the Recipient (ii) The Financing Agreement has
been executed and delivered and all conditions
precedent to its effectiveness have been fulfilled; and
(iii) The Project Operational Manual has been duly
adopted by the Recipient.
Financing Agreement: Section III.B.1(c) The Recipient
may not withdraw the proceeds of the Financing as
allocated for Emergency Expenditures, unless and until:
(i) (A) the Recipient has determined that an Eligible Crisis
or Emergency has occurred, and has furnished to the
Disbursement Association a request to withdraw Financing amounts No Change
under Category (5); and (B) the Association has agreed
with such determination, accepted said request and
notified the Recipient thereof; and (ii) the Recipient has
adopted the CERC Manual and Emergency Action Plan, in
form and substance acceptable to the Association.
Financing Agreement: Section III.B.1(b)/ Grant
Agreement: Schedule 2, Section II.B.1(b) (i) The Recipient
may not withdraw the proceeds of the Financing/Grant
as allocated for PBC Expenditures, unless and until the
Recipient has: (ii) furnished evidence satisfactory to the
Disbursement Association that the Recipient has achieved the No Change
respective PBC Targets; and (iii) complied with the
Disbursement and Financial Information Letter, including
furnished to the Association the applicable interim
unaudited financial reports documenting the incurrence
of PBC Expenditures during the respective PBC period up.
Article 4.01 of the Grant Agreement -- This Agreement
shall not become effective until evidence satisfactory to
the Bank has been furnished to the Bank that the
following conditions have been satisfied: (a) the
Effectiveness Recipient has adopted the updated Project Operations No Change
Manual in form and substance satisfactory to the Bank;
and (b) the execution and delivery of this Agreement on
behalf of the Recipient have been duly authorized or
ratified by all necessary governmental action."
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368)
RESULTS
COUNTRY: Cambodia
Cambodia Health Equity and Quality Improvement Project - Phase 2
@#&OPS~Doctype~OPS^dynamics@afaprresultframework#doctemplate
Project Development Objective(s)
PDO Indicators by PDO Outcomes
For Official Use Only
Baseline Period 1 Period 2 Period 3 Period 4 Completion Period
Improved equitable utilization of health services
1. Outpatient visits by HEF beneficiaries in low utilization ODs (Text)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.44 0.49 0.54 0.62 0.70 0.78
➢ 1.1. Outpatient visits by HEF beneficiaries in select provinces with highest multidimensional poverty (Text)
0.59 0.64 0.69 0.77 0.85 0.93
➢ 1.2. Outpatient visits by female HEF beneficiaries in low utilization ODs (Text)
Full-year utilization of Baseline plus 0.08 per Baseline plus 0.16 per capita
female beneficiaries in capita per year per year
project year 3 for these
ODs will be the baseline, to
be reported at the end of
year 3 after the full PMRS
has been rolled out
nationwide.
➢ 1.3. Outpatient visits by male HEF beneficiaries in low utilization ODs (Text)
Full-year utilization of male Baseline plus 0.08 per Baseline plus 0.16 per capita
beneficiaries in project capita per year per year
year 3 will be the baseline,
to be reported at the end
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368)
of year 3 after the full
PMRS has been rolled out
nationwide.
2.1. Percentage of HEF beneficiaries in all HCs with Full PMRS being introduced in year 1, used the outpatient service paid by HEF (Text)
Jun/2022 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
Full-year utilization of 5 percentage point 10 percentage point 15 percentage point increase
project year 2 will be the increase from baseline increase from baseline from baseline
baseline to be reported in
the end of year 2.
➢ 2.1.1. Percentage of female HEF beneficiaries, in all HC with Full PMRS being introduced in year 1, used the outpatient service paid by HEF (Text)
Full-year utilization of 5 percentage point 10 percentage point 15 percentage point increase
female beneficiaries in increase from baseline increase from baseline from baseline
For Official Use Only
project year 2 will be the
baseline to be reported at
the end of year 2.
➢ 2.1.2. Percentage of male HEF beneficiaries, in all HC with Full PMRS being introduced in year 1, used the outpatient service paid by HEF (Text)
Full-year utilization of male 5 percentage point 10 percentage point 15 percentage point increase
beneficiaries in project increase from baseline increase from baseline from baseline
year 2 will be the baseline
to be reported at the end
of year 2.
2.2. Percentage of HEF beneficiaries in all HCs with Full PMRS being introduced in year 2, used the outpatient service paid by HEF (Text)
Jun/2025 Jun/2026 Jun/2027
Full year utilization of 5 percentage point 10 percentage point increase
project year 3 will be the increase from baseline from baseline
baseline to be reported in
the end of year 3.
➢ 2.2.1 Percentage of female HEF beneficiaries, in all HC with Full PMRS being introduced in year 2, used the outpatient service paid by HEF (Text)
Full-year utilization for 5 percentage point 10 percentage point increase
female beneficiaries in increase from baseline from baseline
project year 3 will be the
baseline to be reported at
the end of year 3.
➢ 2.2.2. Percentage of male HEF beneficiaries in all HCs with Full PMRS being introduced in year 2, used the outpatient service paid by HEF (Text)
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368)
Full-year utilization for 5 percentage point 10 percentage point increase
male beneficiaries in increase from baseline from baseline
project year 3 will be the
baseline to be reported at
the end of year 3.
2.3. Percentage of HEF beneficiaries in all HCs with Full PMRS being introduced in year 3, used the outpatient service paid by HEF (Text)
Jun/2026 Jun/2027
Full year utilization of 5 percentage point increase
project year 3 will be the from baseline
baseline to be reported in
the end of year 4.
➢ 2.3.1. Percentage of female HEF beneficiaries in all HCs with Full PMRS being introduced in year 3, used the outpatient service paid by HEF (Text)
For Official Use Only
Full-year utilization of 5 percentage point increase
female beneficiaries in from baseline
project year 3 will be the
baseline to be reported in
the end of year 4
➢ 2.3.2. Percentage of male HEF beneficiaries, in all HC with Full PMRS being introduced in year 3, used the outpatient service paid by HEF (Text)
Full-year utilization of male 5 percentage point increase
beneficiaries in project from baseline
year 3 will be the baseline
to be reported at the end
of year 4
Improved quality of health services utilized
3. Number of HFs exceeding 60 percent score in the April-May round of semi-annual national quality assessment (Number)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 0.00 150.00 350.00 550.00 700.00
4. Hypertension screening rate (Percentage)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 5.00 17.00 30.00 40.00 50.00
➢ 4.1. Hypertension screening rate among women (Percentage)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 5.00 17.00 30.00 40.00 50.00
➢ 4.2. Hypertension screening rate among men (Percentage)
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 5.00 17.00 30.00 40.00 50.00
5. Number of HFs with Full PMRS introduced routinely collect & report sex, age & geographical location disaggregated data, gender-specific health data (e.g. GBV), & other markers of
disadvantage (Number)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 210.00 520.00 810.00 820.00 820.00
Strengthen Capacity for Health Emergency Prevention Preparedness and Response
6. Percentage of AAR and/or EAR for ONE health outbreak investigations conducted up to 7 days, notified up to 1 day, and responded to up to 7 days, using the 7-1-7 framework
(Percentage)
Jun/2024 Jun/2023 Jun/2024 Jun/2026 Jun/2026 Jun/2027
60 NA 60 (baseline) 65 70 80
For Official Use Only
Intermediate Results Indicators by Components
Baseline Period 1 Period 2 Period 3 Period 4 Completion Period
Component 1: Improving Financial Protection and Utilization of Health Equity Fund
1. Percentage of HEF claims verified by PCA within six working days (Text)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
N/A 100% 100% 100% 100% 100%
2. Percentage of NSSF invoice verified by PCA within six working days (Percentage)
Jun/2021 Jun/2027
0.00 100.00 100.00 100.00 100.00 100.00
3. Total number of HEF utilization (Outpatient and Inpatient visits) (Number)
Jun/2021 Jun/2027
3,277,126.00 3,408,211.00 3,539,296.00 3,670,381.00 3,801,466.00 3,932,551.00
Component 2: Strengthening Quality and Capacity of Health Service Delivery
4. Percent of HFs for which ex-post verification score is more than or equal to 10.5 percent point lower than ex-ante assessment score (Text)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0 0 less than 20% less than 18% less than 16% Less than 15%
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368)
5. Cervical cancer screening rate of target population (Percentage)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 5.00 17.00 30.00 40.00 50.00
6. Number of HCs with established electronic rosters for target population (Number)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 50.00 150.00 250.00 400.00 500.00
7. Number of diabetes patients managed by HCs according to the national protocol (Number)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 0.00 300.00 500.00 600.00 700.00
➢ 7.1. Number of female diabetes patients managed by HCs according to the national protocol (Number)
For Official Use Only
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 0.00 178.00 292.00 345.00 395.00
➢ 7.2. Number of male diabetes patients managed by HCs according to the national protocol (Number)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Nov/2027
0.00 0.00 122.00 208.00 255.00 305.00
8. Percentage of hypertension cases managed by public health facilities according to national protocol (Percentage)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 50.00 55.00 60.00 65.00 70.00
➢ 8.1. Percentage of hypertension cases managed by public health facilities according to the national protocol among women (Percentage)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 50.00 55.00 60.00 65.00 70.00
➢ 8.2. Percentage of hypertension cases managed by public health facilities according to the national protocol among men (Percentage)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 50.00 55.00 60.00 65.00 70.00
People who have received essential health, nutrition, and population (HNP) services (Number)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 2,137,959.00 4,297,121.00 6,477,489.00 8,679,061.00 10,910,837.00
➢ Number of children immunized (Number)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 323,183.00 648,151.00 974,905.00 1,303,445.00 1,633,770.00
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➢ Number of women and children who have received basic nutrition services (Number)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 1,503,782.00 3,025,164.00 4,564,147.00 6,120,729.00 7,694,912.00
➢ Number of deliveries attended by skilled health personnel (Number)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 310,994.00 623,806.00 938,437.00 1,254,887.00 1,573,155.00
Component 3: Project Management, Monitoring & Evaluation, Gender Equality and Social Inclusion
10. Percentage of HFs producing timely financial report as stipulated in the SDG Manual (Percentage)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 15.00 40.00 70.00 100.00 100.00
11. Number of management and health providers trained on GESI standards for health management and service delivery by province and sex. (Text)
For Official Use Only
Jun/2021 Jun/2023 Jun/2024 Jun/2026 Jun/2026 Jun/2027
0 100 managers and 100 additional managers 150 additional managers 150 additional managers 150 additional managers and
technical staff from the and technical staff from and technical staff from and technical staff from technical staff from central
central level to participate central and subnational central and subnational central level and level and subnational levels
in training modules. levels to participate in levels to participate in subnational levels trained. trained and Women in
training modules. training modules. leadership development
program conducted for at least
50 women.
12. Number of data reviews conducted on the utilization of essential health services including NCDs (Number)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 2.00 2.00 2.00 2.00 2.00
13. Percentage of complaints received to the project Grievance Redress Mechanism (GRM) addressed within 60 days (Percentage)
Jun/2021 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0.00 50.00 55.00 60.00 65.00 70.00
Component 4: Strengthening Capacity for Health Emergency Prevention Preparedness and Response
14. Percentage of Points of Entry (PoE) staff trained on vector surveillance and control program. (Percentage)
Jun/2024 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
20 NA 20 (Baseline) 30 40 40
15. SOP for PCR-based primer synthesis and design developed and implemented in NPHL by the end of the third year. (Text)
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2 (P173368)
Jun/2024 Jun/2023 Jun/2024 Jun/2025 Jun/2026 Jun/2027
0 NA 0 (baseline) SOP developed SOP endorsed by MOH SOP implemented in NPHL
For Official Use Only
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2(P173368) PROJECT PAPER
Monitoring & Evaluation Plan:
PDO Indicators by PDO Outcomes
PDO Outcome Improved equitable utilization of health services
Indicator Name 1. Outpatient visits by HEF beneficiaries in low utilization ODs (Text) PBC
Outpatient visits by HEF beneficiaries in ODs with OPD utilization lower than 0.7 per capita per year in the baseline year 2020.
Numerator: Total outpatient visits by HEF beneficiaries in ODs with OPD utilization lower than 0.7 per capita per year in the baseline year
Description/Definition 2020.
Denominator: Total HEF beneficiaries in ODs with OPD utilization lower than 0.7 per capita per year in the baseline year 2020.
(Please see annex 4 for a list of these ODs and utilization rates)
Frequency Semiannual
Data source PMRS/Full PMRS
Methodology for Data
Routine data collection and reporting
Collection
Responsibility for Data
The PCA will report the HEF utilization to DPHI or allow DPHI’s access to the database for conducting data analysis and reporting
Collection
Indicator Name 1.1. Outpatient visits by HEF beneficiaries in select provinces with highest multidimensional poverty (Text) PBC
Outpatient visits per capita per year by HEF beneficiaries in five provinces with lowest multidimensional poverty index at baseline (Mondul
Description//Definition
Kiri, Ratanak Kiri, Kratie, Preah Vihear, and Stung Treng)
Frequency Semiannual
Data source PMRS/ Full PMRS
Methodology for Data
Routine data collection and reporting
Collection
Responsibility for Data
PCA will report the HEF utilization to DPHI or allow DPHI’s access to the database for conducting data analysis and reporting.
Collection
Indicator Name 1.2. Outpatient visits by female HEF beneficiaries in low utilization ODs (Text) PBC
Description Outpatient visits by female HEF beneficiaries in low utilization ODs, as defined in the main indicator
Frequency Semiannual
Data source Full PMRS
Methodology for Data
Routine data collection and reporting analysis and reporting
Collection
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The World Bank
Cambodia Health Equity and Quality Improvement Project - Phase 2(P173368) PROJECT PAPER
Responsibility for Data
PCA will report the HEF utilization to DPHI or allow DPHI’s access to the database for conducting data analysis and reporting.
Collection
Indicator Name 1.3. Outpatient visits by male HEF beneficiaries in low utilization ODs (Text) PBC
Description Outpatient visits by male HEF beneficiaries in low utilization ODs as defined in the main indicator
Frequency Semiannual
Data source Full PMRS
Methodology for Data
Routine data collection and reporting
Collection
Responsibility for Data
PCA will report the HEF utilization to DPHI or allow DPHI’s access to the database for conducting data analysis and reporting.
Collection
Indicator Name 2.1. Percentage of HEF beneficiaries in all HCs with Full PMRS being introduced in year 1, used the outpatient service paid by HEF (Text)
This is an indicator to track improvements in awareness and utilization of HEF benefits by HEF beneficiaries. The project year is from July to
June.
Numerator: Number of HEF beneficiaries who used OPD services reimbursed by HEF in all HCs with Full PMRS being introduced from July
Description
2022–June 2023, year
Denominator: Total number of HEF beneficiaries covered by HEF in the 200 HCs with Full PMRS being introduced
from July 2022–June 2023.
Frequency Annual
Data source Full PMRS
Methodology for Data
Routine data for HEF utilization and HEF beneficiaries from PCA will be used.
Collection
Responsibility for Data
PCA will report the HEF utilization to DPHI or allow DPHI’s access to the database for conducting data analysis and reporting.
Collection
2.1.1. Percentage of female HEF beneficiaries, in all HC with Full PMRS being introduced in year 1, used the outpatient service paid by
Indicator Name
HEF (Text)
Description As defined in the parent indicator
Frequency Annual
Data source Full PMRS
Methodology for Data
Routine data for HEF utilization and HEF beneficiaries from PCA will be used.
Collection
Responsibility for Data
PCA will report the HEF utilization to DPHI or allow DPHI’s access to the database for conducting data analysis and reporting.
Collection
2.1.2. Percentage of male HEF beneficiaries, in all HC with Full PMRS being introduced in year 1, used the outpatient service paid by HEF
Indicator Name
(Text)
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Cambodia Health Equity and Quality Improvement Project - Phase 2(P173368) PROJECT PAPER
Description As defined in the parent indicator
Frequency Annual
Data source Full PMRS
Methodology for Data
Routine data for HEF utilization and HEF beneficiaries from PCA will be used.
Collection
Responsibility for Data
PCA will report the HEF utilization to DPHI or allow DPHI's access to the database for conducting data analysis and reporting.
Collection
Indicator Name 2.2. Percentage of HEF beneficiaries in all HCs with Full PMRS being introduced in year 2, used the outpatient service paid by HEF (Text)
This is an indicator to track improvements in awareness and utilization of HEF benefits by HEF beneficiaries. The project year is from July to
June.
Description Numerator: Number of HEF beneficiaries who used OPD services reimbursed by HEF in all HCs with Full PMRS being introduced from July
2023–June 2024
Denominator: Total number of HEF beneficiaries covered by HEF in all HCs with Full PMRS being introduced from July 2023–June 2024.
Frequency Annual
Data source Full PMRS
Methodology for Data
Routine data for HEF utilization and HEF beneficiaries from PCA will be used.
Collection
Responsibility for Data
PCA will report the HEF utilization to DPHI or allow DPHI’s access to the database for conducting data analysis and reporting.
Collection
2.2.1 Percentage of female HEF beneficiaries, in all HC with Full PMRS being introduced in year 2, used the outpatient service paid by HEF
Indicator Name
(Text)
Description As defined in the parent indicator
Frequency Annual
Data source Full PMRS
Methodology for Data
Routine data for HEF utilization and HEF beneficiaries from PCA will be used.
Collection
Responsibility for Data
PCA will report the HEF utilization to DPHI or allow DPHI’s access to the database for conducting data analysis and reporting.
Collection
2.2.2. Percentage of male HEF beneficiaries in all HCs with Full PMRS being introduced in year 2, used the outpatient service paid by HEF
Indicator Name
(Text)
Description As defined in the parent indicator
Frequency Annual
Data source Full PMRS
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Methodology for Data
Routine data for HEF utilization and HEF beneficiaries from PCA will be used.
Collection
Responsibility for Data
PCA will report the HEF utilization to DPHI or allow DPHI’s access to the database for conducting data analysis and reporting.
Collection
Indicator Name 2.3. Percentage of HEF beneficiaries in all HCs with Full PMRS being introduced in year 3, used the outpatient service paid by HEF (Text)
This is an indicator to track improvements in awareness and utilization of HEF benefits by HEF beneficiaries. The project year is from July to
June.
Description Numerator: Number of HEF beneficiaries who used OPD services reimbursed by HEF in all HCs with Full PMRS being introduced from July
2024–June 2025
Denominator: Total number of HEF beneficiaries covered by HEF in the 300 HCs with Full PMRS being introduced July 2024–June 2025.
Frequency Annual
Data source Full PMRS
Methodology for Data
Routine data for HEF utilization and HEF beneficiaries from PCA will be used.
Collection
Responsibility for Data
PCA will report the HEF utilization to DPHI or allow DPHI's access to the database for conducting data analysis and reporting.
Collection
2.3.1. Percentage of female HEF beneficiaries in all HCs with Full PMRS being introduced in year 3, used the outpatient service paid by
Indicator Name
HEF (Text)
Description As defined in the parent indicator
Frequency Annual
Data source Full PMRS
Methodology for Data
Routine data for HEF utilization and HEF beneficiaries from PCA will be used.
Collection
Responsibility for Data
PCA will report the HEF utilization to DPHI or allow DPHI's access to the database for conducting data analysis and reporting.
Collection
2.3.2. Percentage of male HEF beneficiaries, in all HC with Full PMRS being introduced in year 3, used the outpatient service paid by HEF
Indicator Name
(Text)
Description As defined in the parent indicator
Frequency Annual
Data source Full PMRS
Methodology for Data
Routine data for HEF utilization and HEF beneficiaries from PCA will be used.
Collection
Responsibility for Data
PCA will report the HEF utilization to DPHI or allow DPHI's access to the database for conducting data analysis and reporting.
Collection
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PDO Outcome Improved quality of health services utilized
Indicator Name 3. Number of HFs exceeding 60 percent score in the April-May round of semi-annual national quality assessment (Number) PBC
Description This is an indicator to track the improved quality of HFs and is assessed by the NQEMTs-II.
Frequency Annual
Data source NQEMTs-II ICT system
Methodology for Data Health centers and hospitals are assessed on a semiannual basis against NQEMTs-II. The assessment is conducted by ex-ante assessors,
Collection who report the results to QAO.
Responsibility for Data
QAO
Collection
Indicator Name 4. Hypertension screening rate (Percentage) PBC
Numerator: number of target population screened for hypertension
Description
Denominator: total number of the target population (residents that are ≥40 years old) for hypertension screening
Frequency Semiannual
Data source NCD patient tracking system
Methodology for Data
Reporting from NCD patient tracking ICT system
Collection
Responsibility for Data
PMD
Collection
Indicator Name 4.1. Hypertension screening rate among women (Percentage) PBC
Numerator: number of target female population screened for hypertension
Description
Denominator: total number of target female population (residents that are ≥40 years old) for hypertension screening
Frequency Semiannual
Data source NCD patient tracking system
Methodology for Data
Reporting from NCD patient tracking ICT system
Collection
Responsibility for Data
PMD
Collection
Indicator Name 4.2. Hypertension screening rate among men (Percentage) PBC
Numerator: number of target male population screened for hypertension
Description
Denominator: total number of target male population (residents that are ≥40 years old) for hypertension screening
Frequency Semiannual
Data source NCD patient tracking system
Methodology for Data
Reporting from NCD patient tracking ICT system
Collection
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Responsibility for Data
PMD
Collection
5. Number of HFs with Full PMRS introduced routinely collect & report sex, age & geographical location disaggregated data, gender-
Indicator Name
specific health data (e.g. GBV), & other markers of disadvantage (Number)
Full indicator name: Number of HFs with Full PMRS being introduced routinely collect and report sex, age, and geographical location
disaggregated data, gender specific health data (e.g., GBV), and other markers of disadvantage such as Indigenous status.
The indicator will require an assessment in Year 1 to look at the full package of data and include the GBV collection of data. The
assessment will be done in collaboration with the various agencies within the MOH that will provide exact definitions, criteria for the target
groups and provide DPHI (department in charge of collecting the data) the formula to incorporate the indicators in the system.
Year 1 will also see the rollout of the indicators that are included in the CNP project (covering only 7 provinces) to the remaining provinces.
Description
The remaining GESI data around disability and indigenous status will require consultations and collaboration with other ministries that are
responsible for defining these indicators.
PCA/DPHI will roll out full PMRS to all remaining health centers in the first three years (200 HCs in Year 1, 300 HCs in Year 2, and 300HCs in
Year 3).
DPHI will complete aggregation and finalization of all required information necessary in each year for the HCs/HFs with full PMRS rolled out.
Year 4 will see the roll-out of the full sex-disaggregated data and GESI indicators as agreed with the Government and the World Bank.
Frequency Semiannual
Data source MOH report/HMIS/full PMRS
Methodology for Data
DPHI collects and reports data in collaboration with other agencies
Collection
Responsibility for Data
DPHI
Collection
PDO Outcome Strengthening Capacity for Health Emergency Prevention Preparedness and Response
6. Percentage of AAR and/or EAR for ONE health outbreak investigations conducted up to 7 days, notified up to 1 day, and responded to
Indicator Name
up to 7 days, using the 7-1-7 framework (Percentage)
The number of event reviews of zoonotic outbreaks or public health events among the total number of such occurrences per year.
To calculate the percentage:
• The numerator is the number of zoonotic outbreaks or public health events that have undergone review for detection, notification,
Description
and response aligned with 7-1-7 framework.
• The denominator is the total number of zoonotic outbreaks or public health events that occur within a defined period, such as one
year or three years.
Frequency Annual
Utilize line lists from outbreak investigations or the Cambodia Event Monitoring System’s (CamEMS) record on zoonotic outbreaks or public
Data source
health events. Data are collected from provincial Rapid Response Teams, laboratory officers, clinicians, or other notified sources.
Methodology for Data Calculate the number of zoonotic outbreak events or public health events.
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Collection
Responsibility for Data
MOH-CDC, Oversees Surveillance, Zoonotic Diseases, and the Field Epidemiology Training Program (FETP)
Collection
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Monitoring & Evaluation Plan:
Intermediate Results Indicators by Components
Component Component 1: Improving Financial Protection and Utilization of Health Equity Fund
Indicator Name 1. Percentage of HEF claims verified by PCA within six working days (Text) PBC
This is an indicator to track the timeliness of claims verified by the PCA.
Description Numerator: Number of claims submitted to PCA verified and certified by PCA within six working days
Denominator: Total number of claims submitted to PCA
Frequency Monthly
Data source PMRS
Methodology for Data
PMRS report
Collection
Responsibility for Data
PCA
Collection
Indicator Name 2. Percentage of NSSF invoice verified by PCA within six working days (Percentage)
Description Number of cases claimed by HFs for reimbursement by NSSF being verified by PCA within 6 days
Frequency Monthly
Data source PMRS
Methodology for Data
PMRS report
Collection
Responsibility for Data
PCA
Collection
Indicator Name 3. Total number of HEF utilization (Outpatient and Inpatient visits) (Number)
Description Total number of IPD and OPD cases utilized by HEF beneficiaries.
Frequency Semiannual
Data source Full PMRS
Methodology for Data
Total number of OPD and IPD cases by HEF beneficiaries recorded in the full PMRS
Collection
Responsibility for Data
PCA will report HEF utilization to DPHI for conducting data analysis and reporting.
Collection
Component Component 2: Strengthening Quality and Capacity of Health Service Delivery
Indicator Name 4. Percent of HFs for which ex-post verification score is more than or equal to 10.5 percent point lower than ex-ante assessment score
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(Text)
Numerator: Total number of HFs being verified by the ex-post assessors having ex-post verification score less than 10.5 percent point
Description against the ex-ante scores
Denominator: Total number of HFs being verified by ex-post assessors.
Frequency Semiannual
Data source NQEMT-2 ICT system
Methodology for Data
Result of the ex-post verification conducted by PCA comparing the ex-ante score against the ex-post score.
Collection
Responsibility for Data
QAO/PCA
Collection
Indicator Name 5. Cervical cancer screening rate of target population (Percentage)
Numerator: Number target population screened for cervical cancer screening
Description
Denominator: Total number of the target population (women aged 30–49) for cervical cancer screening
Frequency Semiannual
Data source NCD patient tracking
Methodology for Data
Report from NCD patient tracking system
Collection
Responsibility for Data
PMD/DPHI
Collection
Indicator Name 6. Number of HCs with established electronic rosters for target population (Number)
Description Number of health centers with electronic rosters for target population including ANC, PNC, immunization, and NCD
Frequency Semiannual
Data source NCD patient tracking
Methodology for Data
Routine data
Collection
Responsibility for Data
PMD
Collection
Indicator Name 7. Number of diabetes patients managed by HCs according to the national protocol (Number)
Description Number of diabetes patients managed by HCs according to the treatment protocol
Frequency Semiannual
Data source NCD Patient Tracking
Methodology for Data
Routine Data
Collection
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Responsibility for Data
PMD
Collection
Indicator Name 7.1. Number of female diabetes patients managed by HCs according to the national protocol (Number)
Description Number of female diabetes patients managed by HCs according to the treatment protocol
Frequency Semiannual
Data source NCD Patient Tracking
Methodology for Data
Routine Data
Collection
Responsibility for Data
PMD
Collection
Indicator Name 7.2. Number of male diabetes patients managed by HCs according to the national protocol (Number)
Description Number of male diabetes patients managed by HCs according to the treatment protocol
Frequency Semiannual
Data source NCD Patient Tracking
Methodology for Data
Routine Data
Collection
Responsibility for Data
PMD
Collection
Indicator Name 8. Percentage of hypertension cases managed by public health facilities according to national protocol (Percentage)
Numerator: Number of hypertension cases treated by public health facilities according to the national protocol
Description
Denominator: Total number of people diagnosed with hypertension by public health facilities recommended for treatment
Frequency Semiannual
Data source NCD patient tracking system
Methodology for Data NCD tracking system will track these patients. The patients managed according to the national protocol will be defined based on the
Collection Government protocol for managing hypertensive patients.
Responsibility for Data
PMD
Collection
8.1. Percentage of hypertension cases managed by public health facilities according to the national protocol among women
Indicator Name
(Percentage)
Numerator: Number of hypertension cases among women treated by public health facilities according to the national protocol
Description
Denominator: Total number of women diagnosed with hypertension by public health facilities recommended for treatment
Frequency Semiannual
Data source NCD patient tracking system
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Methodology for Data NCD tracking system will track these patients. The patients managed according to the national protocol will be defined based on the
Collection Government protocol for managing hypertensive patients.
Responsibility for Data
PMD
Collection
Indicator Name 8.2. Percentage of hypertension cases managed by public health facilities according to the national protocol among men (Percentage)
Numerator: Number of hypertension cases among men treated by public health facilities according to the national protocol
Description
Denominator: Total number of men diagnosed with hypertension by public health facilities recommended for treatment
Frequency Semiannual
Data source NCD patient tracking system
Methodology for Data NCD tracking system will track these patients. The patients managed according to the national protocols will be defined based on the
Collection Government protocols for managing hypertensive patients.
Responsibility for Data
PMD
Collection
Indicator Name People who have received essential health, nutrition, and population (HNP) services (Number)
Description
Frequency Semiannual
Data source HMIS
Methodology for Data Routine data: Sum of (a) number of children who received HepB within 24 hours, (b) number of deliveries attended by skilled,
Collection health personnel at public health facilities, and (c) number of women and children who have received basic nutrition services
Responsibility for Data
DPHI
Collection
Indicator Name Number of children immunized (Number)
Description
Frequency Semiannual
Data source HMIS
Methodology for Data
Routine data, Cumulative number of newborns vaccinated with HepB within 24 hours of birth, as a proxy indicator
Collection
Responsibility for Data
DPHI
Collection
Indicator Name Number of women and children who have received basic nutrition services (Number)
Description
Frequency Semiannual
Data source HMIS
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Methodology for Data Routine data: Cumulative number of children ages 6–59 months received Vitamin A supplementation in second round and
Collection cumulative number of pregnant women received 90 tablets iron/folic acid
Responsibility for Data
DPHI
Collection
Indicator Name Number of deliveries attended by skilled health personnel (Number)
Description
Frequency Semiannual
Data source HMIS
Methodology for Data
Routine data: Cumulative number of deliveries attended by skilled health personnel at public health facilities
Collection
Responsibility for Data
DPHI
Collection
Component Component 3: Project Management, Monitoring & Evaluation, Gender Equality and Social Inclusion
Indicator Name 10. Percentage of HFs producing timely financial report as stipulated in the SDG Manual (Percentage) PBC
DBF, with support from ODs’ and PHDs’ Accountants to provide handholding/on -site training/coaching to HFs in producing timely financial
Description
reports according to the SDG Manual
Frequency Annual
Data source DBF report from ODs
Methodology for Data
DBF will collect the table prepared by ODs showing the timeline of monthly financial reports prepared by health facilities.
Collection
Responsibility for Data
DBF
Collection
11. Number of management and health providers trained on GESI standards for health management and service delivery by province and
Indicator Name
sex (Text)
Number of management and health providers trained on GESI standards for health management and service delivery by province and sex.
Description Please note that this indicator is also linked with PBC 7. As the portal only allows for one PBC to be linked with one indicator, we have
linked PBC 7 on GESI with the main GESI indicator (PDI 5).
Frequency Annual
Data source GMAG
Methodology for Data
Reporting by GMAG supported by training sign-in sheet, hotel bill, and etc.
Collection
Responsibility for Data
GMAG and DPHI
Collection
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Indicator Name 12. Number of data reviews conducted on the utilization of essential health services including NCDs (Number) PBC
Number of routine reviews conducted by DPHI and PMD to review the utilization of essential health services (ANC, PNC,
Description
delivery at health facilities, family planning, and immunization) including NCDs
Frequency Semiannual
Data source DPHI Reports
Methodology for Data
Routine reporting
Collection
Responsibility for Data
DPHI
Collection
Indicator Name 13. Percentage of complaints received to the project Grievance Redress Mechanism (GRM) addressed within 60 days (Percentage)
Numerator: Total number of complaints addressed within 60 days
Description
Denominator: Total number of complaints received within last 6 months
Frequency Semiannual
Data source MOH admin data/semiannual project program report
Methodology for Data
Routine monitoring
Collection
Responsibility for Data
MOH
Collection
Component Component 4: Strengthening Capacity for Health Emergency Prevention Preparedness and Response
Indicator Name 14. Percentage of Points of Entry (PoE) staff trained on vector surveillance and control program. (Percentage)
This indicator will gauge the capacity of PoE staff required under the International Health Regulations (IHR) 2005.
To calculate the percentage:
Description
Numerator: Count the number of PoE staff attending training on vector surveillance and control
Denominator: Total number of PoE staff
Frequency Annual
Data source Training reports
Methodology for Data
Training reports
Collection
Responsibility for Data Quarantine Bureau and PoE staff, MOH-CDC, MOH
Collection
Indicator Name 15. SOP for PCR-based primer synthesis and design developed and implemented in NPHL by the end of the third year. (Text)
A primer is a short, single-stranded nucleic acid used by all living organisms in initiating DNA synthesis. The polymerase chain reaction (PCR)
Description employs a pair of custom primers to direct DNA elongation toward each other at opposite ends of the sequence being amplified. These
primers must code for only the specific upstream and downstream sites of the sequence being amplified.
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Frequency Annual
Data source SOP for PCR-based primer synthesis and design at NIPH virology laboratory
Methodology for Data
The annual meeting/workshop will review the activity related to this indicator. The number of SOPs will be tallied at that time.
Collection
Responsibility for Data
NIPH Virology Laboratory
Collection
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Verification Protocol:
Performance Based Conditions
PBC Indicator Name 1 : Improved HEF Management (Text)
Formula NA
This PBC will finance DPHI’s expenditures for (a) updating HEF benefit package and service reimbursement rates; (b) conducting semiannual
review on HEF utilization and annual project review workshop, including review implementation on HEF utilization; (c) producing
semiannual HEF utilization analysis reports; (d) preparing Action Plan for routine collection of gender and other GESI-related disaggregated
Description
data, and gender-specific data; (d) routinely producing gender and other GESI disaggregated data, and gender-specific data, and gender-
based violence data from HMIS/DHIS2/PMRS; and (e) promoting the awareness of the HEF benefit package.
Target (a) Year 1 to Year 5; target (c) Year 2 to Year 3; and target (b) Year 4 to Year 5 are time bound.
1. Consultation report for updating HEF benefit package and service reimbursement rates; 2. Official documents to prove that the new HEF
benefit package and new service reimbursement schedule have been developed and adopted; 3. Semi-annual and annual workshop
Data source/ Agency invitation, participant sign-in sheet, venue renting invoice; 4. Semi-annual HEF analysis reports produced and submitted to the Association
by December; (5) GESI implementation action plan, progress on GESI implementation action plan, and gender-based violent data; and 6.
HEF promotion activities conducted via social media and the HEF promotion material both soft copies and hard copy distributed to HFs.
Verification Entity Result verification working group/verification agency. Verification procedures will be defined in the verification protocol.
Desk review of reports submitted with supporting documents/evidence. Randomly sampled follow-up call to be conducted as necessary to
Procedure
validate the reported achievement.
PBC Indicator Name 2 : Expanded PCA Functions and Service Coverage (time bound except for target c for year 1-3) (Text)
Formula NA
This PBC will finance NPCA’s expenditures for (a) conducting timely verification of HEF claim, quality verification, validation diabetes,
hypertension and cervical cancer screening, and case management services; (b) strengthening and expanding its capacity to carry out the
Description tasks defined above; and (c) rolling out the full PMRS to remining 800 HCs and 20 RHs.
This PBC is time bound except for target (b) Year 1 and target (c) Year 2. The disbursement will be made when each target is validated as
fully achieved.
1. Meeting invitation, meeting participant sign in sheet, meeting venue renting invoice, certificate issued; 2. Documents proven that
supervision, coaching, semi/annual reviews conducted; 3. Documents proven contracting of consultants; 4. Reports of claim validation,
Data source/ Agency diabetes and hypertension screening and treatment (DHS&T) and CCS&T screening and case management services; 5. quality verification
repot of NQEMTs-II; 6. Document proven the roll-out of full PMRS to HCs and RHs; and 7. Reports of claim verification for HEF for identified
poor and at risk group.
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Verification Entity Result verification working group/verification agency. Verification procedures will be defined in the POM verification protocol.
Desk review of reports submitted with supporting documents/evidence. Randomly sampled follow-up call to be conducted as necessary to
Procedure
validate the reported achievement.
PBC Indicator Name 3 : Enhanced Quality of Health Service as defined in NQEMTs-II by MOH (Text)
Formula NA
This PBC will finance QAO’s expenditures for (a) building PHD and OD assessor teams to conduct NQEMTs-II; (b) building the capacity of HCs
and PHs/RHs to improve quality of healthcare service delivery; (c) developing 40 new clinical vignettes and their respective coaching
protocols, and knowledge tests to be added in implementation of NQEMTs-II for improving knowledge and competency of health facility
Description
staff; and (d) conducting supervisions as necessary to improve the implementation of NQEMTs-II as well as the performance of HFs.
All targets of this PBC are not time bound except target (a) Year 1 and Year 5, and target (b) for Year 5 are time bound, which means MOH
can continue to implement in the following years, but the disbursement will be made only when the target has been achieved.
1. Supporting evidence to confirm training/workshop has been provided such as official invitation, participant sign in sheet,
training/workshop venue renting invoice, and certificate issued; 2. Documents proven that supervision, coaching, semi/annual reviews
Data source/ Agency
conducted; 3. NQEMTs-II data generated from the NQEMTs-II ICT system; 4. quality verification report; and 5. Document proving approval
of the new clinical vignettes and their respective coaching protocols.
Verification Entity Result verification working group/verification agency. Verification procedures will be defined in the verification protocol.
Desk review of reports submitted with supporting documents/evidence. Randomly sampled follow-up call to be conducted as necessary to
Procedure
validate the reported achievement.
PBC Indicator Name 4 : Rolling out of NCD Services and Cervical Cancer Screening —National (Text)
Formula NA
This PBC will finance PMD’s expenditures for (a) updating national standard operation procedures for implementing DHS&T and CCS&T
management; (b) providing TOT to PHDs and ODs in 22 provinces for providing cascade training to HC staff; (c) training all remaining 53 RHs
and 61 RHs for diagnosing and treating severe/complicated diabetes, hypertension and cervical lesion cases; (d) performing supportive
Description supervision and coaching and conducting programs’ semi/annual reviews; and (e) preparing and implementing the national Health
Promotion Program.
Target (a) is time bound across year 1 to year 5; target (b), (c), (d) and (e) of year 1 are not time bound; and target (b) across year 2 to year 5
are time bound.
1. Supporting evidence to confirm training/workshop has been provided such as official invitation, participant sign in
sheet,training/workshop venue renting invoice, and certificate issued; 2. Documents proven that supervision, coaching, semi/annual
Data source/ Agency reviews conducted; 3. Documents proven that supervision, coaching, semi/annual reviews conducted; 3. Documents proven that the
national plan or standard operation procedures developed and adopted; and 4. Documents proven the National Health Promotion Program
developed and health promotion activities completed every year according to the annual operational plan.
Verification Entity Result verification working group/verification agency. Verification procedures will be defined in the verification protocol.
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Desk review of reports submitted with supporting documents/evidence. Randomly sampled follow-up call to be conducted as necessary to
Procedure
validate the reported achievement.
PBC Indicator Name 5 : Rolling out of NCD Services and Cervical Cancer Screening – Subnational Level (scalable, non-time bound) (Text)
Formula NA
This PBC will finance PHDs’ and ODs’ expenditures for rolling out DHS&T and CCS&T to 810 new HCs and 500 new HCs respectively, and
ensure the achievement of NCD screening targets. The expenditures include (a)training HC staff to provide DHS&T and CCST&T services; (b)
procure and providing equipment and consumables to health centers and NCD clinics; and (c) conduct supportive supervision, review
Description workshops, monitoring and reporting.
All targets of this PBC are scalable and non-time bound, except for year 5 which time bound, meaning partial disbursement is allowed based
on the formula and linking with partial achievement. If the target for certain year is not achieved in that year, MOH can continue
implementing in the following years, but the disbursement will only be made when the target has been achieved.
1. Supporting evidence to confirm training has been provided such as official invitation, participant sign in sheet, training/workshop venue
renting invoice, and certificate issued; 2. Documents proven that supervision, coaching, semi/annual reviews conducted; 3. Documents
Data source/ Agency
proven procurement/distribution of equipment, consumables, and other supplies according to the items and qualities defined in Annual
Operational Plan; and 4. Validation report of achievement of screening targets.
Verification Entity Result verification working group/verification agency. Verification procedures will be defined in the verification protocol.
Desk review of reports submitted with supporting documents/evidence. Randomly sampled follow-up call to be conducted to validate the
Procedure
reported achievement.
6 : Timely processing of project funds and improved capacity of sub-national HFs in applying relevant financial management system
PBC Indicator Name
(Text)
Formula NA
This PBC will finance the necessary project expenditures required for (a) DBF to ensure timely payment of HEF grant and performance-
based SDG to sub-national HFs, ODs, and PHDs and (b) DBF, with support from ODs’ and PHDs’ Accountants to provide hand-holding/on-site
Description
training/coaching to HFs in producing timely financial reports according to the SDG Manual.
Target (a) of Years 1–5 is time bound; target (b) of Years 1–4 is scalable and non-timebound.
(1) Payment record in accounting system of DBF; 2. A table prepared by OD showing a timeline of which Desk review of reports submitted
Data source/ Agency with supporting documents/evidence; 3.documetn proven the monthly financial reports are produced by HFs; and 4,Documents proven
that on-site training/supervision/coaching conducted.
Verification Entity Result verification working group/verification agency. Verification procedures will be defined in the verification protocol.
(a) DBF will extract timeline of payment dates (the length of time for payment from the receipt of PCA-certified invoice) and provide it to
Procedure IVA who will check to see if the payment is within 5 working days from the receipt of certified invoices. Randomly sampled follow-up call to
be conducted to validate the reported achievement
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(b) DBF will collect the table prepared by OD showing the timeline of monthly financial reports prepared by HFs and provide it to IVA. IVA
will review the table to see if the monthly financial reports are produced no later than the deadline stated in the SDG manual. IVA can
request for a copy of monthly financial reports, on a sample basis, for review and verification.
PBC Indicator Name 7 : Implementation of Gender Equality and Social Inclusion Action Plan (scalable, non-time bound) (Text)
Formula NA
This indicator is to measure the implementation of Gender Equality and Social Inclusion Action Plan each year according to the annual
Description operational plan. The annual workplan will be developed and agreed by the pooled fund partners. This PBC (except for target for Year 5) is
scalable and not time bound. Target for Year 5 is time bound and non-scalable.
1. GMAG will be responsible to monitor, collect and report on the data; 2. Report developed according to the agreed template; 3.
documents proven training provided such as official training invitation, participant sign-in sheet, record of certificate issued; 4. Documents
Data source/ Agency proven policy roundtable conducted such as official invitation, participant sign-in sheet, venue renting invoice, policy report, presentations
and etc.; and 5. documents proven the annual operational plan developed every year and the activities defined in the plan completed
according to the annual operational plan.
Verification Entity Result verification working group/verification agency. Verification procedures will be defined in the verification protocol.
Desk review of reports submitted with supporting documents/evidence. Randomly sampled follow-up call to be conducted to validate the
Procedure
reported achievement.
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