The World Bank Report No: ISR14644 Implementation Status & Results India India: Tamil Nadu Health Systems Project (P075058) Public Disclosure Copy Operation Name: India: Tamil Nadu Health Systems Project (P075058) Project Stage: Implementation Seq.No: 19 Status: ARCHIVED Archive Date: 30-Jul-2014 Country: India Approval FY: 2005 Product Line: IBRD/IDA Region: SOUTH ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Tamil Nadu Health Systems Project Key Dates Board Approval Date 16-Dec-2004 Original Closing Date 30-Sep-2010 Planned Mid Term Review Date 26-Nov-2007 Last Archived ISR Date 15-Jan-2014 Effectiveness Date 27-Jan-2005 Revised Closing Date 30-Sep-2014 Actual Mid Term Review Date 21-Nov-2007 Project Development Objectives Project Development Objective (from Project Appraisal Document) The PDO is to significantly improve the effectiveness of the health system in Tamil Nadu as measured by (i) increased access to andutilization of maternal and neo-natal care services, particularly by poor, disadvantaged and tribal groups; (ii) effective non-communicable disease interventions scaled-up throughout the state; (iii) improved health outcomes, access and quality of service delivery through strengthened oversight of the public sector health systems and greater engagement of the non- government sector; and (iv) increased effectiveness of public sector hospital services, primarily at district and sub-district levels. Has the Project Development Objective been changed since Board Approval of the Project? ● Yes No Component(s) Component Name Component Cost Increasing access to and utilization of services 33.79 NCD Prevention and Control 5.65 Building capacity for oversight and management of the health system 25.61 Improving effectiveness and efficiency of the public sector to deliver essential services 40.90 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Implementation Status Overview The project continues to be on track to achieve its development objectives based on the results available from the implementation support mission of November 2013. The next Page 1 of 8 The World Bank Report No: ISR14644 implementation support mission for the project is scheduled from July 17-25, 2014 when the Results Framework would be updated and another status report filed subsequent to the mission. Locations Public Disclosure Copy Country First Administrative Division Location Planned Actual India State of Tamil Nadu State of Tamil Nadu Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target At least 23% of complicated maternal Percentage Value 23.00 39.40 23.00 admissions at certified project CEmONCS Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 (state wide) will be for SC/ST patients Comments Indicator calculated as: No: of Indicator calculated as: No: of Maintain percentage SC/ST complicated maternal SC/ST complicated maternal admissions / total complicated admissions / total complicated Indicator calculated as: No: of maternal admissions in maternal admissions in SC/ST complicated maternal certified project CEmONCs X certified project CEmONCs X admissions / total complicated 100 100 maternal admissions in certified project CEmONCs X 100 Effective functioning of CEmONCs (state wide) Percentage Value 35.00 69.90 35.00 as measured by percentage of complicated Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 admissions Comments Indicator calculated as: No: of Indicator calculated as: No: of Maintain percentage complicated admissions / total complicated admissions / total admissions at CEmONCs X admissions at CEmONCs X Indicator calculated as: No: of 100 100 complicated admissions / total admissions at CEmONCs X 100 Risk adjusted maternal case fatality rate Number Value 13.33 6.18 13.33 Date 30-Nov-2009 30-Sep-2013 30-Sep-2014 Public Disclosure Copy Comments for Phase I CEmONCs For 55 identified, designated Maintain baseline rate CEmONCs Indicator calculated as: [(No: Indicator calculated as: [(No: of maternal case deaths at t2/ Indicator calculated as: [(No: of maternal case deaths at t2/ No: of maternity admissions of maternal case deaths at t2/ No: of maternity admissions at t2) X 100000] / [(No. of No: of maternity admissions at t2) X 100000] /[(No. of complicated maternal at t2) X 100000] / [(No. of complicated maternal admissions in t2/total no: of complicated maternal admissions in t2/total no: of maternal admissions in t2)/ admissions in t2/total no: of maternal admissions in t2)/ (No. of complicated maternal maternal admissions in t2)/ (No. of complicated maternal Page 2 of 8 The World Bank Report No: ISR14644 admissions in t1/total no: of (No. of complicated maternal admissions in t1/total no: of maternal admissions in t1)] admissions in t1/total no: of maternal admissions in t1)] maternal admissions in t1)] Risk adjusted neonatal case fatality rate Number Value 4.08 4.00 4.08 Public Disclosure Copy Date 30-Nov-2009 30-Sep-2013 30-Sep-2014 Comments for Phase I CEmONCs for 55 identified, designated Maintain baseline rate CEmONCs Indicator calculated as: [(No: Indicator calculated as: [(No: of neonatal case deaths at t2/ Indicator calculated as: [(No: of neonatal case deaths at t2/ No: of neonatal admissions at of neonatal case deaths at t2/ No: of neonatal admissions at t2) X 1000] / [(No.of No: of neonatal admissions at t2) X 1000] / [(No. of complicated maternal t2) X 1000] / [(No. of complicated maternal admissions in t2/total no: of complicated maternal admissions in t2/total no: of maternal admissions in t2)/ admissions in t2/total no: of maternal admissions in t2)/ (No. of complicated maternal maternal admissions in t2)/ (No. of complicated maternal admissions in t1/totalno: of (No. of complicated maternal admissions in t1/total no: of maternal admissions in t1)] admissions in t1/total no: of maternal admissions in t1)] maternal admissions in t1)] Scale-up of cancer cervix screening and Text Value Cervical cancer screening Cancer cervix screening and Scale up on the basis of pilot cardio-vascular disease prevention and control operational in Theni and CVD prevention and control evaluation based on a comprehensive assessment of Thanjavur; interventions for pilot scaled up to all 32 pilots cardiovascular disease districts of state prevention and control opertional in Sivagangai and Virudhunagar Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 Comments Percentage of women in targetted age group Percentage Value 85.00 18.70 50.00 (ages 30-60 years) screened for cervical Sub Type cancer in districts where program is operational Supplemental Percentage of eligible persons screened for Percentage Value 54.00 25.50 50.00 CVD in districts where program operational Public Disclosure Copy Sub Type Supplemental Improved access to health care, as measured Number Value 36.70 by inpatient utilization of services by the Date 30-Sep-2010 30-Sep-2014 poorest of the population: proportion of Comments Indicator calculated as: No: of Data will be available by Increased utilization rate by population reporting ailment in last 15 days (36.7 per 1000) people who reported ailment August 2014 the poorest (as measured by in last 15 days/No: of people an asset index) surveyed X 1000 Indicator calculated as: No: of people who reported ailment Indicator calculated as: No: of Page 3 of 8 The World Bank Report No: ISR14644 in last 15 days/No: of people people who reported ailment surveyed X 1000 in last 15 days/No: of people surveyed X 1000 Improved efficiency of services as measured Percentage Value 81.00 85.00 Public Disclosure Copy by Bed occupancy rate Date 30-Sep-2009 30-Sep-2013 30-Sep-2014 Comments Indicator calculated as: Total Indicator calculated as: Total Maintain baseline rate or no: of IP days for the month / no: of IP days for the month / increase total no: of bed days for the total no: of bed days for the month X 100 month X 100 Indicator calculated as: Total no: of IP days for the month / total no: of bed days for the month X 100 Improved patient satisfaction as shown by Text Value Overall satisfaction score is periodic surveys 3.96 Date 30-Sep-2006 30-Sep-2013 30-Sep-2014 Comments Endline survey report will be Maintain or increase patient available in August-2014. satisfaction. Strengthened state-level capacity of Text Value TNMSC is responsible for TNMSC is responsible for A comprehensive state wide pharmaceuticals and medical supplies procurement and AMCs of procurement and AMCs of system established for all procurement, repair and maintenance of medical equipment medical equipment medical equipment, medical equipment procurement, maintenance and repair Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 Comments Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Health personnel receiving training (number) Number Value 0.00 98807.00 87662.00 Date 06-Aug-2010 31-Oct-2013 30-Sep-2014 Comments Effectiveness date of AF In addition to 77277 trained 87662 with 2402 for Public Disclosure Copy phase of project staff till the last mission: CEmONCs; 24000 for CaCx; CEmONCs: 1200; CaCx and 15360 for CVD; 44000 for Indicator is a cumulation of all CVD: 9,774; HCWM: 6,235; HCWM and 1900 Others. personnel trained under others: 4,321 project Indicator is a cumulation of all Indicatoris a cumulation of all personnel trained under personnel trained under project project Health facilities constructed, renovated, and/or Number Value 0.00 3789.00 3670.00 equipped (number) Date 06-Aug-2010 30-Sep-2013 30-Sep-2014 Page 4 of 8 The World Bank Report No: ISR14644 Comments Effectiveness date of AF 130 CEmONCs and 8 CEmONCS + 1710 health phase of project EmONCs; 1670 centers on facilities participating in CaCx the CVD clinical program, screening and treatment Indicator is a cumulation of all 1710 centers for CaCx and program + 1670 health Public Disclosure Copy health facilities constructed, CaB clinical program, 267 facilities participating in HTN renovated and/or equipped secondary health facilities on screening and treatment under project HMS program, 12 GHs on program + 270 HMS hospitals accreditation program + 12 hospitals for accreditation Indicator is a cumulation of all health facilities constructed, Indicator is a cumulation of all renovated and/or equipped health facilities constructed, under project renovated and/or equipped under project Staffing of CEmONCs according to agreed Percentage Value 77.00 100.00 85.00 norms (2 OBGYN, 2 pediatricians, 1 Date 30-Nov-2009 30-Sep-2013 30-Sep-2014 anesthetist) in 80 CEmONCs Comments 77% in Phase I CEmONCs; 75 CEmONCs with 4 Staffing according to norms 38% in Phase II CEmONCs ONGYNs, 2 pediatricians and maintained at least at 85% of 2 anesthetists; the CEmONC centers Indicator calculated as: No: of 50 EmONCs with 2 OBGYNs, Phase I CEmONCs with 2 pediatricians and 1 Indicator calculated as: No: of staffing as per agreed norms/ anesthetist (100% of result Phase I CEmONCs with Total no: of Phase I achieved) staffing as per agreed norms/ CEmONCs X 100 Total no: of Phase I Indicator calculated as: No: of CEmONCs X 100 Phase I CEmONCs with staffing as per agreed norms/ Total no: of Phase I CEmONCs X 100 Increased provision of health services to tribal Number Value 2.00 4.00 4.00 population by way of number of NGO hospitals Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 providing bed grants Comments Public Disclosure Copy Increased provision of health services to tribal Number Value 2.00 3.00 3.00 populations by way of number of NGO Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 hospitals providing testing, counseling and Comments treatment services for sickle cell anemia Increased provision of health services to tribal Number Value 32.00 41.00 populations by way of number of patient Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 counselors at primary and secondary Comments healthfacilities in tribal areas Page 5 of 8 The World Bank Report No: ISR14644 Increased emergency transport services Number Value 113570.00 392874.00 measured by the number of people transported Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 Comments Increase numbers over Public Disclosure Copy baseline No: of district hospitals with provision of Number Value 0.00 48.00 20.00 support services Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 Comments No: of schools in which health promotion Number Value 50.00 16369.00 5000.00 activities for prevention of CVD conducted. Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 Comments Percentage of those reporting ailment in last 15 Percentage Value 82.80 days who accessed any form of care Date 30-Sep-2010 30-Sep-2014 Comments Indicator calculated as: no: of Household survey report will Increased utilization rate by persons accessing any form be secured in August 2014. the poorest (as measured by of care/No: of persons an asset index) reporting ailment in last 15 Indicator calculated as: no: of days X 100 persons accessing any form Indicator calculated as: no: of of care/No: of persons persons accessing any form reporting ailment in last 15 of care/No: of persons days X 100 reporting ailment in last 15 days X 100 Number of hospitalization cases per 1000 Number Value 32.10 Date 30-Sep-2010 30-Sep-2014 Comments Indicator calculated as: no: of Household survey report will Indicator calculated as: no: of hospitalization cases/no: of be secured in August 2014. hospitalization cases/no: of cases reporting ailment in last cases reporting ailment in last 15 days and who accessed Indicator calculated as: no: of 15 days and who accessed any form of care X 1000 hospitalization cases/no: of any form of care X 1000 cases reporting ailment in last 15 days and who accessed Public Disclosure Copy any form of care X 1000 Strengthen M&E by way of number of hospitals Number Value 0.00 267.00 270.00 with an operational HMS used for management Date 30-Nov-2009 30-Sep-2013 30-Sep-2014 and decision making Comments HMS/HMIS operational in 267 facilities HMIS operational across state Yes/No Value No Yes Yes Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 Comments Page 6 of 8 The World Bank Report No: ISR14644 No: of hospitals submitting monthly reports for Number Value 80.00 271.00 270.00 hospital based quality circles of excellence Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 Comments Public Disclosure Copy No: of project facilities implementing integrated Number Value 270.00 449.00 270.00 health care waste management plans Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 Comments Project Management Unit integrated into Yes/No Value No Yes Yes Department of Health Date 30-Sep-2010 30-Sep-2014 Comments Mechanism established for planning and Yes/No Value No Yes Yes implementing IEC activities in health sector and Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 monitoring PPP activities Comments Establish a health data resource center in TN Yes/No Value No No Yes Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 Comments Contract awarded, SRS being defined TNMSC strengthened as per plan Text Value None The activity has been taken TNMSC strengthened per over by GoTN in totality agreed plan, including mainstreaming of biomedical engineers Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 Comments No: of additional contractual staff in 270 project Number Value 0.00 2906.00 2394.00 hospitals in accordance with agreed norms Date 30-Sep-2010 30-Sep-2013 30-Sep-2014 Comments 437 doctors, 744 nurses, 110 pharmacists, 111 lab technicians, 7 radiographers, 29 ANMs, 460 hospital Public Disclosure Copy workers, 467 sanitary workers, 2 dental surgeons, 27 cooks Data on Financial Performance (as of 30-Jun-2014) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P075058 IDA-40180 Closed 16-Dec-2004 05-Jan-2005 27-Jan-2005 30-Sep-2010 30-Sep-2010 Page 7 of 8 The World Bank Report No: ISR14644 Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P075058 IDA-47560 Effective 29-Apr-2010 06-Jul-2010 06-Aug-2010 30-Sep-2013 30-Sep-2014 Disbursements (in Millions) Public Disclosure Copy Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P075058 IDA-40180 Closed XDR 73.90 60.64 13.26 60.64 0.00 100.00 P075058 IDA-47560 Effective XDR 77.60 77.60 0.00 60.71 16.89 78.00 Disbursement Graph Key Decisions Regarding Implementation The Government of Tamil Nadu has requested the Bank through the Department of Economic Affairs, for an extension of the project Closing Date by 12 months until September 30, Public Disclosure Copy 2015 to further support strengthened operationalization of (i) Phase II the scale up of the non-communicable disease (NCD) screening and treatment program; and (ii) Phase III of the Health Management Information System (HMIS) which is being deployed to 20 medical colleges and 39 allied Department of Medical Education (DME) Institutions. Restructuring History CD Decision on 28-Jun-2010 Related Projects P118830-Tamil Nadu Health Additional Financing Page 8 of 8