The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Sint Maarten Hospital Resiliency & Preparedness Project (P167532) LATIN AMERICA AND CARIBBEAN | St Maarten | IBRD/IDA | Investment Project Financing (IPF) | FY 2019 | Seq No: 13 | Archived on 23-Dec-2024 | ISR02714 Implementing Agencies: Sint Maarten Medical Center (SMMC) 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Decision package on 16-Aug-2018) Improve the preparedness and capacity of hospital services in Sint Maarten Has the Development Objective been changed since Board Approval of the Project Objective? Yes Current Development Objective (Approved as part of Additional Financing package Seq. 2 on 22-Aug-2023) Improve the preparedness and capacity of hospital services in Sint Maarten 2. COMPONENTS Name Building and launching of the new hospital:(Cost 24,000,000,000,000.00) Transition and Contingency Plan for Sint Maarten Medical Center:(Cost 11,085,000,000,000.00) Project Management:(Cost 525,000,000,000.00) 3. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Low Low Dec 23, 2024 Page 1 of 9 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) 4. KEY ISSUES & STATUS 4.1 Implementation Status and Key Decisions Following approval in August 2018, the Sint Maarten Hospital Resiliency and Preparedness Project was formally launched in October 2018, with the objective of the capacity and preparedness of hospital services in Sint Maarten. This project is not only supporting financing towards a new hospital building resilient to Category 5 storms, but also improvements to the expansion and quality of hospital services for the population of Sint Maarten. In August 2023, a second additional grant in the amount of US$7 million was approved to help cover a cost overrun resulting from an increase in the cost of construction. The project was also restructured in August 2023 to modify the results framework and extend the original grant’s closing date to May 31, 2025. Significant progress on the new hospital construction continues with fast-track activities (such as the water tanks, installation of base isolators and wastewater treatment plant) completed, as well as the pouring of the ground floor sections. Recent progress has also been made on strengthening hospital service delivery preparedness, e.g., the SMMC Facilities Department held tabletop drills in May and June 2024 and covered evacuation routes, the emergency disaster plan, emergency codes, emergency access points, and fire safety plans (including fire simulation and extinguisher trainings). The essential upgrades to the existing facility (all completed) have made an important contribution to improving the capacity of hospital services as well as SMMC’s progress towards transitioning to the new building. As a result, the scope of current hospital services has been expanded and overseas referrals have been reduced over the past five years. Activities supported by the project have contributed to repairing structural damages caused by Hurricane Irma; increasing safety, preparedness and overall resilience of the current hospital; expanding the capacity of select services (e.g., dialysis, chemotherapy, and operating rooms) and providing new services (e.g., ophthalmology, neurology, urology, etc.), among others. 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Last Approved Rating Risk Category Approval Package - ISR Seq. 012 - 05 Sep Proposed Rating 16 Aug 2018 2024 Political and Governance Substantial Moderate Moderate Macroeconomic Substantial Moderate Moderate Sector Strategies and Policies Moderate Low Low Technical Design of Project or Program Moderate Low Low Institutional Capacity for Implementation and Substantial Low Low Sustainability Fiduciary Substantial Moderate Moderate Dec 23, 2024 Page 2 of 9 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Overall Substantial Low Low Dec 23, 2024 Page 3 of 9 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes Improve capacity of hospital services Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 0.00 May/2018 85.00 19-Jun-2024 87.00 30-Sep-2024 45.00 Jul/2024 Overseas medical referrals Comments on This indicator measures the percent decrease in the number of overseas medical referrals. A reduced (Percentage) achieving targets referral is defined based on the date SMMC determines they cannot provide treatment at SMMC. This data is as of FY24, Q2 due to time needed to process, validate and report on data. Improve preparedness of hospital services Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 60.00 May/2018 91.80 19-Jun-2024 92.30 30-Sep-2024 90.00 May/2025 Comments on Tabletop drills were held in May/June 2024 and covered evacuation routes, the emergency achieving targets disaster plan, emergency codes, emergency access points, and fire safety plans (including fire Emergency Disaster simulation and extinguisher trainings). Six members also participated in the May 31 Hurricane Preparedness Plan and Preparedness Session. Following these trainings, the scorecard for the EDP and Evacuation Evacuation Plan implemented Plan at SMMC are currently rated at 9.23 out of 10 or 92.3 percent, surpassing the Project's according to procedures end-target of 90 percent. This score is broken down into 8.89 for the Emergency and (Percentage) Evacuation Plan and 9.57 for Hurricane Preparedness. Further scoring improvements are dependent on (1) updating the hospital floor plans (delayed due to the ongoing expansion); (2) completing fire drills 2x rather than 1x each year (as is expected in 2025); and (3) continuing fire extinguisher training for all staff. Due to the Page 4 of 9 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) hospital's solid concrete walls, two scorecard indicators are marked as "Partially Met" and will not be achievable. 0.00 May/2018 40.00 19-Jun-2024 40.00 30-Sep-2024 90.00 May/2025 Comments on Internal technical audits will determine whether updated clinical guidelines (CGs) and quality achieving targets control mechanisms have been implemented satisfactorily. A draft audit tool for technical Technical audits to evaluate audits has been prepared for use, while the process for updating CGs continues. quality and preparedness of service delivery rated The reported data reflects the first technical audit of five (of 10 targeted) CGs, in which only 4 satisfactory (Percentage) CGs were deemed as having a satisfactory rating. In May 2024, a second audit was conducted however it was considered a “pilot” audit given SMMC is working to further refine the tracers and scoring methodology. WB feedback on the audit methodology (including revised KPIs) is being taken into account for the next technical audit, planned for Q1 CY2025. 6.2 Intermediate Results Indicators by Components Building and launching of the new hospital Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 0.00 May/2018 29 19-Jun-2024 32.30 30-Sep-2024 45.00 May/2025 Comments on There has been a 3.3% increase since the last reporting period (June 2024). This indicator Progress in construction of achieving targets measures the percentage progress in construction of the new hospital as per Category 5 plus new hospital as per category specifications. The end-target was revised downward to 45% as part of the July 2023 5 plus specifications restructuring to appropriately reflect that construction was not projected to be completed (Percentage) during the lifetime of the project. The 45% end-target is derived from the construction timetable. The deign phase is also included in the calculation as part of the overall progress in construction. Page 5 of 9 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Emergency Disaster No Jun/2018 Yes 29-Dec-2023 Yes 29-Dec-2023 Yes Jul/2024 Preparedness Plan and Comments on End target achieved. As such, the end-target date for this indicator was not extended to reflect Evacuation Plan updated achieving targets the Project's new closing date. (Yes/No) 0.00 Jun/2018 373.00 19-Jun-2024 410.00 30-Sep-2024 300.00 May/2025 Health personnel trained Comments on End-target surpassed. As of June 2024, the training programs supported by this Project have (Number) achieving targets benefitted 373 participants, reflecting an increase of 72 participants since end-2023. Storage capacity to improve 82.00 Jun/2018 400.00 07-Mar-2023 400.00 07-Mar-2023 208.00 Jul/2024 preparedness (Square Comments on End target surpassed. Meter(m2)) achieving targets 60.00 May/2018 60.00 29-Dec-2023 60.00 29-Dec-2023 20.00 Jul/2024 Comments on **No category 2 events have occurred during the reporting period to allow for reporting on Impact of extreme weather achieving targets this indicator.** conditions on hospital services (admissions, This indicator measures the percent change of services provided 60 days before and 60 days referrals, surgeries) after an extreme weather event to gauge the impact of the event on the hospital's capacity to (Percentage) remain operational. The specific services tracked will include the number of admissions, surgeries and referrals. Extreme weather conditions include Category 2 hurricanes and higher. In the possible case of multiple, back to back extreme weather events, the indicator would measure 60 days before the first event and 60 days after the las event. Transition and Contingency Plan for Sint Maarten Medical Center Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 0.00 Jun/2018 100.00 29-Dec-2023 100.00 29-Dec-2023 100.00 Jul/2024 Progress in essential upgrades Comments on End target achieved. This indicator measures the percent progress of essential upgrades to the existing hospital achieving targets completed to the existing facility. All essential upgrades were completed as of end-June 2023. (Percentage) As such, the end-target for this indicator was not be extended to reflect the Project's new closing date. Page 6 of 9 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Contingency Plan in place for No Jun/2018 Yes 29-Dec-2023 Yes 29-Dec-2023 Yes Jul/2024 continuous services during Comments on End target achieved. An updated contingency plan (fall back scenario in case of disasters) works and reallocation of achieving targets remains in place for continuous services during works and reallocation of services. services (Yes/No) 60.00 Jun/2018 82.40 19-Jun-2024 84.90 30-Sep-2024 85.00 May/2025 Increased patient satisfaction Comments on Data from SMMC patient satisfaction surveys, reflecting a 2.5% increase since June 2024 (Percentage) achieving targets Increased patient 0.00 Jul/2018 81.40 29-Dec-2023 85 30-Sep-2024 85.00 May/2025 satisfaction - females Comments on Data from SMMC patient satisfaction surveys, reflecting a 2.5% increase since June 2024. (Percentage) achieving targets 0.00 Jun/2018 12 19-Jun-2024 5 30-Sep-2024 10.00 May/2025 Updated clinical guidelines for Comments on Because the May 2024 audit of seven CGs is being considered a pilot, the number of CGs prevalent health problems achieving targets implemented and evaluated is revised downward from 12 to 5 accordingly. 52 CPGs have been implemented and evaluated updated, and the next audit is planned for Q1 of 2025, after which this indicator will be (Number) updated. It remains on track for achievement by project closure. Hospital implemented a triage No Mar/2020 Yes 29-Dec-2023 Yes 29-Dec-2023 Yes Jul/2024 and treatment system including split services between COVID-19 and non- COVID-19 patients (Yes/No) Number of additional hospital 0.00 Mar/2020 16.00 29-Dec-2023 16.00 29-Dec-2023 16.00 Jul/2024 beds to manage and treat Comments on End target achieved. The Auxiliary Care Facility has a total of sixteen beds, of which six are COVID-19 suspected and achieving targets intensive care beds and 10 are medium care beds to manage and treat COVID-19 suspected confirmed patients. and confirmed cases. (Number) Page 7 of 9 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) 7. DATA ON FINANCIAL PERFORMANCE 7.1 Cumulative Disbursements 7.2 Disbursements (by loan) Loan/Credit/TF Status Original Revised Cancelled Disbursed Undisbursed % Disbursed Historical Disbursed TF-B3788 Closed 3.61 3.61 0.00 3.61 0.00 100.00 3.61 % TF-A8176 Effective 25.00 25.00 0.00 23.69 1.31 94.76% 25.00 TF-C2387 Effective 7.00 7.00 0.00 1.07 5.93 15.33% 7.00 7.3 Key Dates (by loan) Dec 23, 2024 Page 8 of 9 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing TF-A8176 Effective 10-Aug-2018 22-Aug-2018 06-Sep-2018 31-Jul-2023 31-May-2025 TF-B3788 Closed 26-Aug-2020 03-Sep-2020 30-Oct-2020 31-Jul-2024 31-Jul-2024 TF-C2387 Effective 22-Aug-2023 05-Dec-2023 21-Dec-2023 31-May-2025 31-May-2025 8. KEY DATES Key Events Planned Actual Approval 21-Aug-2018 16-Aug-2018 Effectiveness 06-Sep-2018 06-Sep-2018 Mid-Term Review No. 01 31-Aug-2021 19-Aug-2021 Operation Closing/Cancellation 31-May-2025 9. RESTRUCTURING HISTORY Restructuring Level 2 Approved on 31-Jul-2023 10. ASSOCIATED OPERATION(S) There are no associated operations Dec 23, 2024 Page 9 of 9