The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Transforming Egypt's Healthcare System Project (P167000) MIDDLE EAST AND NORTH AFRICA | Egypt, Arab Republic of | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2018 | Seq No: 3 | ARCHIVED on 10-Sep-2019 | ISR38295 | Implementing Agencies: Ministry of Investment and International Cooperation, Ministry of Health and Population Key Dates Key Project Dates Bank Approval Date: 27-Jun-2018 Effectiveness Date: 07-Sep-2018 Planned Mid Term Review Date: 14-Jan-2021 Actual Mid-Term Review Date: Original Closing Date: 31-Dec-2023 Revised Closing Date: 31-Dec-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed Project Development Objective is to (i) improve the quality of primary and secondary health care services, (ii) enhance demand for health and family planning services, and (iii) support the prevention and control of Hepatitis C. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Strengthen Primary Healthcare, Family Planning and Community Activities:(Cost $247.40 M) Strengthen Secondary Level Healthcare:(Cost $274.60 M) Institutional Capacity Building and Project Management:(Cost $8.00 M) Contingency Emergency and Response Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions This is the third ISR for the Project, which was approved by the Board on June 27, 2018, with the Loan Agreement signed on July 10, 2018. The project was declared effective on September 7, 2018, well ahead of the envisioned Effectiveness date at project design. Project Implementation: The project is making good progress. Overall, Implementation Progress and progress towards achievement of the Project Development Objective are rated as Satisfactory, the disbursement rate is well ahead of schedule at 34% and a functioning Project Management Unit (PMU) is in place. The screening of Hep C and NCDs has exceeded its targets and been completed two years earlier than planned. The Project Operations Manual has been finalized, the Grievance Redress Mechanism manual is in the process of being updated, and the technical Independent Verification Agency has been identified and is on board for the project. 9/10/2019 Page 1 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Sustainability Moderate Moderate Moderate Fiduciary High High High Environment and Social Moderate Moderate Moderate Stakeholders Substantial Substantial Substantial Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improve the quality of primary health care services IN00736007 ►Number of PHCs passing Quality Services Index composite indicators list (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 600.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 The QSI manual and action plan for targeted PHC staff training have been completed. Quality Comments: improvement activities are ongoing for batched I and II. IN00736131 ►Percentage improvement in the average quality of clinical care score at all targeted PHCs, measured through independent direct observations (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 9/10/2019 Page 2 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) A pilot study by the IVA for the clinical score assessment tool is now running in two PHCs in Alexandria. Comments: The survey is planned for September 2019. Improve the quality of secondary health care services IN00736010 ►Percentage improvement in the average quality of clinical care score at all targeted hospitals measured through independent direct observations (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 IN00736132 ►Percentage of blood units dispensed at MOHP affiliated hospitals that have been screened utilizing the Nucleic Acid test (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 90.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 Procurement activities have already started. Comments: Enhance Demand for Health and Family Planning Services IN00736009 ►Contraceptive prevalence rate (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 58.00 58.00 58.00 65.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 Data for this indicator is not required until year 3 of project life. Comments: Prevention and control of Hepatitis C IN00736008 ►Number of people screened for Viral Hepatitis C (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 43,458,006.00 49,903,177.00 35,000,000.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 The end target for the screen of Hepatitis C has been met (and exceeded) 3 years earlier than planned. Comments: IN00736133 Percent Female (Percentage, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 52.49 52.00 50.00 9/10/2019 Page 3 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 29-Dec-2023 IN00736134 ►Percentage of people who received treatment for Hepatitis C who have taken the final confirmation test for sustained virological response (SVR) using a random sampling methodology (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 89.00 80.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 The end target has been met (and exceeded) three years ahead of schedule Comments: Intermediate Results Indicators by Components Strenghten Primary Healthcare, Family Planning and Community Activities IN00736135 ►PHC mapping exercise, needs assessments and new accreditation tool completed. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 1.00 4.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 The PHC needs assessments have been completed and the mapping exercises are underway, with Comments: completion expected by the end of November, 2019. IN00736138 ►Increased household visits by CHWs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7.00 7.00 7.00 32.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 This indicator is measured yearly. Activities related to CHWs is on-going. With the exception of the Menya Governorate, the contracting of new CHWs is almost completed, training is being conducted and CHWs Comments: are expected to begin work by the end of August, 2019. IN00736140 ►Percentage of participating districts certified for enhanced governance performance (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 The curriculum for financial training (65 district) has been completed and will be revised from both the procurement and financial aspects. The action plan for the training has been completed and delivery of Comments: training will commence shortly. IN00736142 ►Client user satisfaction and utilization surveys conducted in project target areas (Number, Custom) 9/10/2019 Page 4 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 5.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 A pilot study for patient satisfaction tool is now running in two PHCs in Alexandria. Survey is due on Comments: September 2019. IN00736144 ►Grievances addressed in project target facilities using the GRM in accordance with the revised manual issued in 2017 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 The GRM manual is being updated and once completed will be printed and distributed in 600 PHCs. A target of 840 health staff from different levels will be trained on the GRM. For year one of the project, it is Comments: only required to update, distribute and train staff on the manual. No requirement to handle claims as per the new GRM yet. IN00736146 ►Average patient satisfaction level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 65.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 A pilot study for patient satisfaction tool is now running in two PHCs in Alexandria by the IVA. Survery is Comments: due on September 2019. IN00736147 ►Targeted people screened for NCDs (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 43,458,006.00 49,903,177.00 20,000,000.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 The end target has been met (and exceeded) 3 years ahead of schedule. Comments: IN00736148 Percent Female (Percentage, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 52.49 52.00 50.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 29-Dec-2023 IN00736149 ►Targeted PHCs applying environmentally-positive energy and water efficiency measures (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 600.00 9/10/2019 Page 5 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 The Needs Assessment for energy saving lamps, has been completed for the targeted Comments: PHCs. Approximately 20.000 energy saving lamps are needed for the 600 PHCs. IN00736150 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 864,248.00 3,400,000.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 Services were delivered from January 1 to June 30, 2019 Comments: IN00736151 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 864,248.00 3,400,000.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 Strengthen Secondary Level Healthcare IN00736137 ►Targeted regional blood banks that have been connected to the national automated blood network. (Amount(USD), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 11.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 IN00736139 ►Targeted Hep C patients treated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 215,053.00 1,012,797.00 1,500,000.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 The year 4 target has been met, 3 years early. Comments: IN00736141 Percent Female (Percentage, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40.00 Date 20-Jun-2018 22-Mar-2019 15-Aug-2019 29-Dec-2023 IN00736143 ►Number of PHCs receiving National Accreditation Certification for healthcare quality (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 9/10/2019 Page 6 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Value 0.00 0.00 0.00 600.00 Date 02-Jul-2018 21-Sep-2018 15-Aug-2019 31-Dec-2023 Facilities must first undergo QSI certification. This indicator is a delayed requirement. Comments: IN00736145 ►Number of Hospitals receiving National Accreditation Certification for healthcare quality in target governorates (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 27.00 Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 The tool for accreditation is not yet published Comments: Institutional Capacity Building ad Project Management IN00736136 ►Project results published regularly on external MOHP website (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Data related to Hep C and NCD screening is Value 0.00 No reports Yes published on the MOPH website Date 02-Jul-2018 22-Mar-2019 15-Aug-2019 31-Dec-2023 Data related to Hep C and NCD screening is published on the MOPH website. By the end of the 4th quarter of 2019 , more information related to the project and its progress will be published on the Comments: website. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P167000 IBRD-88950 Effective USD 530.00 530.00 0.00 179.46 350.54 34% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P167000 IBRD-88950 Effective 27-Jun-2018 10-Jul-2018 07-Sep-2018 31-Dec-2023 31-Dec-2023 Cumulative Disbursements 9/10/2019 Page 7 of 8 The World Bank Implementation Status & Results Report Transforming Egypt's Healthcare System Project (P167000) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 9/10/2019 Page 8 of 8