The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) Uttarakhand Health Systems Development Project (P148531) SOUTH ASIA | India | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 9 | ARCHIVED on 07-Dec-2020 | ISR44043 | Implementing Agencies: Republic of India, Department of Medical Health and Family Welfare, Government of Uttarakhand Key Dates Key Project Dates Bank Approval Date: 26-Jan-2017 Effectiveness Date: 23-May-2017 Planned Mid Term Review Date: 31-Jul-2020 Actual Mid-Term Review Date: 26-Oct-2020 Original Closing Date: 30-Sep-2023 Revised Closing Date: 30-Sep-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to improve access to quality health services, particularly in the hilly districts of thestate, and to expand health financial risk protection for the residents of Uttarakhand Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Innovations in engaging the private sector:(Cost $48.88 M) Stewardship and system improvement component:(Cost $38.62 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Satisfactory Overall Risk Rating Substantial Moderate Implementation Status and Key Decisions The Mid-term Review determined that the UKHSDP has turned in a positive direction with substantial implementation progress over the last six months, despite the myriad of challenges posed by COVID-19. Specifically, lockdowns and travel restrictions that have made it difficult for the PIT to provide oversight and management of activities in the districts, recruiting additional staff to the PIT has been delayed as selected candidates from outside of Uttarakhand have not accepted offers, and many PIT staff and health providers have themselves contracted COVID-19. Commitments have increased significantly from only 20% in April 2020 to 72% in October 2020. Additionally, new procurements of US$15 million are expected to be committed by March 2021. The longstanding staffing gaps in the Project Implementation Team (PIT) have been filled with around 70% of the positions currently filled. Both technical and operational capacities of the PIT have been strengthened, which is critical for the growing monitoring, supervision and management needs in this next phase of UKHSDP implementation. As a result of implementation progress in many areas, the ratings for implementation progress and for the likelihood of achieving the project development objective (PDO) are rated “Moderately Satisfactory”. While great progress and commitment have been demonstrated by the Government of Uttarakhand, a restructuring of the project is suggested to align with an evolving state context (no need for health insurance based on Atal Ayushman Yojana and PM-JAY combined with a need 12/7/2020 Page 1 of 8 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) to support the state’s COVID-19 response). This will be processed shortly and is expected to help consolidate implementation, accelerate pace of implementation and related disbursements. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Moderate Moderate Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- Substantial Moderate Technical Design of Project or Program -- Substantial Moderate Institutional Capacity for Implementation and -- Substantial Moderate Sustainability Fiduciary -- Substantial Substantial Environment and Social -- Moderate Moderate Stakeholders -- Substantial Substantial Other -- -- -- Overall -- Substantial Moderate Results PDO Indicators by Objectives / Outcomes Innovations in engaging the private sector IN00911216 ►Number of outpatient visits to Primary Health Centers (PHCs), CHCs, and mobile vans per year, disaggregated by districts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 774,926.00 3,256,588.00 1,165,548.00 1,150,000.00 Date 31-Mar-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Data for April-2020 to September 2020 Comments: IN00911218 ►Number of hospital admissions and outpatient consultations covered by any form of health insurance supported by the project (RSBY and MSBY), disaggregated by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/7/2020 Page 2 of 8 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) Value 46,040.00 126,678.00 74,747.00 100,000.00 Date 29-Jul-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Data for April-2020 to September-2020 (these data are for Atal Ayushman Uttarakhand Yojana (AAUY), predecessor scheme to RSBY/MSBY) Comments: Female:42,312; Male: 32,435 Potential indicator for deletion during restructuring – project isn’t supporting health insurance given state has already extended coverage to all residents under AAUY Stewardship and system improvement component IN00911217 ►Number of persons who used the Health Helpline to receive information or lodge grievances, disaggregated by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 81,192.00 70,931.00 64,736.00 160,000.00 Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Data for - April-2020 to September-2020 Comments: Female: 15,382; Male: 32,673; Others: 16,681 Potential indicator for deletion during restructuring – project isn’t supporting this IN00911219 ►Patients contacted by the Health Helpline that are satisfied with the health services provided to them (per year, disaggregated by gender) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 9.30 70.00 Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Data for - April-2020 to September-2020 Comments: Total calls (incoming and outgoing): 64,736; Total satisfaction calls: 6033 Potential indicator for deletion during restructuring – project isn’t supporting this IN00911220 ►Number of government and non-government healthcare facilities in the state issued with an entry (or higher) level certification by the National Accreditation Board for Hospitals (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 4.00 4.00 8.00 Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 As on September 30, 2020: 4 non-govt facilities have NABH certification Comments: Intermediate Results Indicators by Components 12/7/2020 Page 3 of 8 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) Innovations in engaging the private sector IN00911221 ►People with access to any form of health insurance in the state during the year, disaggregated by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 921,584.00 10,086,292.00 10,086,292.00 3,000,000.00 Date 31-Dec-2014 31-Mar-2020 30-Sep-2020 31-Mar-2023 Data as on September 30, 2020 Total: 10,086,292; Female: 4,948,519; Male: 5,137,773 Comments: Potential indicator for deletion during restructuring – project isn’t supporting health insurance given state has already extended coverage to all residents under AAUY IN00911223 ►Number of children covered under the expanded health insurance program who received an annual health assessment during the year, disaggregated by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 200,000.00 Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Since there has been change in insurance program to cover entire population of the state, decision on expansion of insurance program to cover children separately has not been taken. This is a potential Comments: indicator for deletion during restructuring – project isn’t supporting health insurance given state has already extended coverage to all residents under AAUY IN00911225 ►Number of patients who use the services provided by the mobile health vans, disaggregated by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 104,122.00 46,644.00 22,210.00 300,000.00 Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Data for - April-2020 to September-2020 Total: 22,210; Female: 11,560; Male: 10,650 Comments: This data is for the number of OPDs and not the number of patients; data on the number of patients not available with the state. This indicator needs to be reworded during the restructuring. IN00911226 ►Number of mobile medical units complying with the requirement of having at least one female doctor with sonology certification (>90% compliance on a day-to-day basis) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 9.00 Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 This indicator needs to be deleted due to legal change on ultrasounds - mobile health units can not Comments: provide ultrasound services anymore in the country. IN00911227 12/7/2020 Page 4 of 8 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) ►Number of outsourced CHCs with utilization of emergency services reported during each month (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 8.00 Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Data for - April-2020 to September-2020 Comments: IN00911228 ►Number of outsourced CHCs where at least one emergency caesarean section was reported during each quarter (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 6.00 Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Data for - April-2020 to September-2020 Comments: IN00911229 ►Benefit package of child health services finalized and piloted (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 No No 'yes' from year 2 Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Potential indicator for deletion during restructuring – the project isn’t supporting health insurance provided Comments: under AAUA IN00911230 ►Benefit package of NCDs services finalized and piloted (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target "no" for the first three Value 0.00 No No years and "yes" from year 4. Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Potential indicator for deletion during restructuring – the project isn’t supporting health insurance provided Comments: under AAUA IN00911231 ►Share of eligible households successfully enrolled under RSBY/MSBY during the year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.70 100.00 100.00 50.00 Date 31-Dec-2014 31-Mar-2020 30-Sep-2020 31-Mar-2023 Potential indicator for deletion during restructuring – the project isn’t supporting health insurance provided Comments: under AAUA 12/7/2020 Page 5 of 8 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) IN00911232 ►Number of specialists working in the outsourced health facilities (and augmenting the positions functionally vacant in the public system) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 25.00 15.00 30.00 50.00 Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Data as of September 30, 2020 Comments: IN00911233 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 140,631.00 174,794.00 88,948.00 180,000.00 Date 31-Mar-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Number of children immunized. Comments: Data for - April-2020 to September-2020 IN00911234 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 140,631.00 174,794.00 88,948.00 180,000.00 Date 31-Mar-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Stewardship and system improvement component IN00911222 ►Health personnel receiving training financed by the project- cumulative (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3.00 7,796.00 5,000.00 Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 Data as of September 30, 2020 Comments: IN00911224 ►Development and periodical update of a comprehensive disaster response plan at the state level (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Done by year 2, Value 0.00 No No updated by year revised by year 6. Date 25-Nov-2016 31-Mar-2020 30-Sep-2020 31-Mar-2023 12/7/2020 Page 6 of 8 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) PIT is under process of hiring an agency to develop disaster management plan for the state Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P148531 IDA-59480 Effective USD 100.00 70.00 30.00 6.38 63.62 9.1% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P148531 IDA-59480 Effective 26-Jan-2017 23-Mar-2017 23-May-2017 30-Sep-2023 30-Sep-2023 Cumulative Disbursements 12/7/2020 Page 7 of 8 The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History Level 2 Approved on 30-Oct-2020 Related Project(s) There are no related projects. 12/7/2020 Page 8 of 8