The World Bank Case Study on Integrated Delivery of Selected Non-Communicable Diseases in Kenya (P164301) REPORT NO.: RES37665 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF CASE STUDY ON INTEGRATED DELIVERY OF SELECTED NON-COMMUNICABLE DISEASES IN KENYA APPROVED ON AUGUST 22, 2017 TO NATIONAL TREASURY HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Hafez M. H. Ghanem Country Director: Carlos Felipe Jaramillo Global Director: Muhammad Ali Pate Practice Manager/Manager: Ernest E. Massiah Task Team Leader(s): Miriam Schneidman The World Bank Case Study on Integrated Delivery of Selected Non-Communicable Diseases in Kenya (P164301) ABBREVIATIONS AND ACRONYMS AMPATH Academic Model Providing Access to health care CHVs Community Health Volunteer M&E Monitoring and Evaluation MOH Ministry of Health MTRH Moi Teaching and Referral Hospital NCD Non Communicable Diseases The World Bank Case Study on Integrated Delivery of Selected Non-Communicable Diseases in Kenya (P164301) Note to Task Teams: The following sections are system generated and can only be edited online in the Portal. BASIC DATA Product Information Project ID Financing Instrument P164301 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 22-Aug-2017 31-Mar-2020 Organizations Borrower Responsible Agency National Treasury Moi Teaching and Referral Hospital,Ministry of Health Financing (in USD Million) FIN_SUMM_PUB_TBL SUMMARY Total Project Cost 0 Total Financing 0 Financing Gap 0 DETAILS -NewFin3 The World Bank Case Study on Integrated Delivery of Selected Non-Communicable Diseases in Kenya (P164301) Project Development Objective (PDO) Original PDO Implement and evaluate a pilot program for prevention and management of selected NCDs at community and primary care levels complemented by cost effective referral linkages in two counties of Kenya. The proposed RETF will support the Republic of Kenya (ROK) to develop and pilot models of integrated NCD care at community and primary care levels in selected counties that can inform the national scale up. Specifically, the RETF will lead to the production of a case study, documenting the main features of the model of care, and lessons learned to inform interventions that are scalable and sustainable. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing Net TF Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed TF-A5636 22-Aug-2017 12-Sep-2017 28-Feb-2018 31-Mar-2020 2.50 .50 2.00 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No Note to Task Teams: End of system generated content, document is editable from here. The World Bank Case Study on Integrated Delivery of Selected Non-Communicable Diseases in Kenya (P164301) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING Note: Formatting instructions for this document. A. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING The US$2.5 million Case Study on Integrated Delivery of Selected Non-Communicable Diseases in Kenya (P163187) has been supporting the Government of Kenya to develop, pilot, and evaluate a chronic care model for select NCDs at community and primary care levels in Busia and Trans-Nzoia counties and to strengthen referral systems across different levels of care. To this end, the project has provided technical support to: (i) ascertain knowledge, attitudes and practices of patients and providers; (ii) establish the effectiveness of alternative community education and screening strategies and different linkage and referral strategies; (iii) demonstrate the feasibility and scalability of a chronic care model for select NCDs; and (iv) evaluate the costs of these interventions and the cost effectiveness of the screening, linkage, referral and care strategies. Significant progress has been made in implementing project activities, including establishment of community screening systems, provision of equipment and medicines, and establishment of patient linkages to care. Despite solid progress, disbursement remains relatively low but is expected to rise shortly once the full US$1.5 million approved for this fiscal year is disbursed to MTRH. Despite these protracted bureaucratic and administrative delays in channeling funds, the implementing agency Moi Teaching and Referral Hospital (MTRH)/ AMPATH has remained committed to delivering the project, advancing its own funds to move forward the necessary research. A 15-month no cost extension of the closing date is required to allow the counties to complete all program activities and consolidate achievements. The extension will enable the project team to complete the data collection and analysis; develop/ finalize case studies; and document lessons learnt in project scaling up as well as benefit from US$.5 million mobilized in parallel for an evaluation. There is currently no outstanding Audit Reports from the Ministry of Health. The implementation of the pilot NCD project has generated important lessons in terms of how services should be organized, delivered, and financed. The main achievements to date can be summarized as follows: a) Component 1: Delivery of NCD Services. The MTRH/ AMPATH has established strong partnerships with the Government of Kenya, funding organizations, and local communities to leverage the existing HIV and primary care platforms for chronic diseases. With support of the project, critical equipment was procured, and operating budgets were provided (internet services, office supplies, logistical support, staff) to support screening and referral services, awareness creation and education, treatment, and county-level advocacy for diabetes, hypertension, breast and cervical cancer. Between July and December 2019, a total of 28,222 people was screened for diabetes; 63,809 people for hypertension; 3,202 people for diabetes and hypertension; and 4,173 people for cervical/ breast cancer. b) Component 2: Monitoring and Evaluation of NCD Pilot. As part of this component, MTRH/ AMPATH has leveraged education and outreach strategies to increase awareness on NCDs. The baseline survey and focus group discussions on attitudes towards NCDs were conducted between October and December 2018. In the July – December 2019 period, a total of 214 community education events were conducted; 73 health facilities, 1130 health volunteers, and 238 healthcare providers were trained on NCD care; and 36 active NCD support groups (total of 670 members) were created. Research analysts and a health economist have been contracted to evaluate the cost effectiveness of screening, linkage, referral and care strategies. Data quality and review meetings are held regularly, health information systems are being strengthened through unified community registers for NCDs, and an evaluation using the RE-AIM framework is planned to assess reach, adoption, implementation process, and ongoing maintenance activities. The World Bank Case Study on Integrated Delivery of Selected Non-Communicable Diseases in Kenya (P164301) II. DESCRIPTION OF PROPOSED CHANGES Note: Formatting instructions for this document. Extension of the Closing Date The proposed change concerns a no-cost extension of the closing date of the original grant of US$2,500,000 by 15 months (from March 31, 2020 to June 30, 2021) to allow full disbursement of funds against originally planned activities. The extension will allow the implementation agency to complete the scheduled list of activities, including completing the data collection process, documenting the main features of the model of care, and identifying lessons learnt to inform scalable interventions, and disseminating key findings. Note to Task Teams: The following sections are system generated and can only be edited online in the Portal. III. SUMMARY OF CHANGES Changed Not Changed Loan Closing Date(s) ✔ Disbursement Estimates ✔ Implementing Agency ✔ Project's Development Objectives ✔ Results Framework ✔ Components and Cost ✔ Cancellations Proposed ✔ Additional Financing Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Change in Overall Risk Rating ✔ Safeguard Policies Triggered ✔ EA category ✔ The World Bank Case Study on Integrated Delivery of Selected Non-Communicable Diseases in Kenya (P164301) Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline TF Status Closing Closing(s) Closing for Withdrawal Applications TF-A5636 Effective 31-Mar-2020 30-Jun-2021 30-Oct-2021 OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Change in Disbursement Estimates Yes Year Current Proposed 2018 0.00 0.00 2019 0.00 0.00 2020 0.00 0.00 2021 0.00 0.00 2022 0.00 0.00 Note to Task Teams: End of system generated content, document is editable from here.