The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Emergency Tuberculosis Project (P160947) EAST ASIA AND PACIFIC | Papua New Guinea | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 5 | ARCHIVED on 03-May-2019 | ISR36815 | Implementing Agencies: Department of Treasury, National Department of Health Key Dates Key Project Dates Bank Approval Date: 31-May-2017 Effectiveness Date: 25-Sep-2017 Planned Mid Term Review Date: 19-Nov-2019 Actual Mid-Term Review Date: -- Original Closing Date: 30-Jun-2022 Revised Closing Date: 30-Jun-2022 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To Improve the quality and expand the coverage and utilization of health services to control the spread of tuberculosis in targeted areas of Papua New Guinea by strengthening programmatic management of tuberculosis. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Early detection of active tuberculosis patients:(Cost $3.55 M) Effective treatment of drug-susceptible and drug-resistant tuberculosis patients:(Cost $7.70 M) Strengthening government systems for managing its health services delivery and tuberculosis response:(Cost $3.75 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 High High Implementation Status and Key Decisions Implementation is now progressing well on all Project components: (i) Systematic screening of the population for TB in Daru was completed in November 2018 with support from the Australia Department of Foreign Affairs and Trade (DFAT) and World Bank retroactive financing. Due to the high refusal rate in the systematic screening, a mop-up screening is underway as planned, and expected to be completed soon. Overall, progress on loss to follow up indicators in Daru indicate the potential contribution that early detection can make to a successful TB control strategy. Insights based on systematic screening in Daru will be reflected in the design of a future systematic screening exercise in the National Capital District (NCD), a second hotspot for TB in PNG and potential accelerator of TB transmission in PNG; (ii) Activities to strengthen diagnostic capacity are underway with the contracting of UNOPS and WHO; (iii) With Technical Assistance from WHO, the NTP has updated the treatment 5/3/2019 Page 1 of 9 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) guidelines for Drug Resistant (DR) TB to include the shorter treatment regimen--this has reduced the duration of the treatment for DR TB to nine months with treatment cost about half of the cost of the longer Multi-Drug Resistant (MDR)-treatment regimen--a total of 66 DR TB patients in NCD and 21 in Daru were started on the shorter regimen in 2018; and (iv) WHO has assisted NCD Health and the National TB Program with the regular monitoring and supervision of TB control services in Basic Management Units in NCD and Western Province. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Low Low Low Institutional Capacity for Implementation and Sustainability High High High Fiduciary High High High Environment and Social Low Low Moderate Stakeholders Substantial Substantial Substantial Other -- -- High Overall High High High Results PDO Indicators by Objectives / Outcomes To Improve the quality and expand the coverage and utilization of health services to control the spr IN00695324 ►Number of people receiving tuberculosis treatment in accordance with the national guidelines (NCD) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 6,169.00 5,982.00 6,783.00 7,100.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 A total of 6,783 TB patients enrolled in 2018 and all 14 BMUS reported (Kilakila BMU is closed) during 2018 with a total of 56 reports received. With the GeneXpert expansion planned for 2019, TB case Comments: notification is expected to increase in NCD over the next few years. IN00695325 ►Number of people receiving tuberculosis treatment in accordance with the national guidelines (Daru/South Fly District, Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 5/3/2019 Page 2 of 9 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Value 1,659.00 786.00 551.00 1,900.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 Baseline value does not match case notification rate of 480 in 2016 TB case notification report. A total of 551 TB cases (438 DS and 113 DR) were enrolled in treatment in Daru in 2018. Daru is the only Comments: BMU in South Fly District. IN00695376 ►The proportion of TB patients who have received drug-sensitivity testing (DST) (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 1.50 23.00 80.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 The current indicator is no longer routinely reported, and has be obtained from the DR TB Register. The most up-to-date WHO guidance states that all presumptive TB patients should be tested with GeneXpert, Comments: which assesses Rifampicin resistance. IN00695377 ►The proportion of TB patients who have received DST (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 41.00 4.50 71.00 80.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 The current indicator is no longer routinely reported, and has be obtained from the DR TB Register. The most up-to-date WHO guidance states that all presumptive TB patients should be tested with GeneXpert, Comments: which assesses Rifampicin resistance. IN00695378 ►TB treatment success rate for DS TB (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 56.00 77.00 78.00 85.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 IN00695379 ►TB treatment success rate for DS TB (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 71.00 83.00 86.00 85.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 IN00695380 ►TB treatment success rate for DR TB (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 44.00 44.00 64.00 75.00 Date 31-Aug-2016 30-Aug-2017 31-Dec-2018 30-Jun-2022 Comments: No update available. 5/3/2019 Page 3 of 9 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) IN00695381 ►TB treatment success rate for DR TB for females (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 61.00 75.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 31-Dec-2021 Data for this indicator is not routinely collected and has to be collected separately from the TB Register at Comments: the facilities registering DR TB patients. IN00695382 ►TB treatment success rate for DR TB (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 49.00 79.00 87.00 75.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 IN00695383 ►TB treatment success rate for DR TB for females (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 71.40 0.00 0.00 75.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 Data for this indicator is not routinely collected and has to be collected separately from the TB Register at the facilities registering DR TB patients. These data will be updated in the subsequent semi-annual Comments: progress report. IN00695384 ►Number of BMUs where all clinical staff have been trained/ retrained on TB and DR TB (NCD & Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 20.00 16.00 20.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 One of the BMUs has closed driving the reduction in numbers. Comments: Intermediate Results Indicators by Components Early detection of active tuberculosis patients IN00695385 ►Population-based screening in Daru is complete (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes 5/3/2019 Page 4 of 9 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Date 31-Aug-2016 01-Nov-2018 31-Dec-2018 30-Jun-2022 The first round of population-based screening has been completed with 60% of the total population eligible for screening screened. A mop-up screening is currently underway. An evaluation will be done Comments: afterward. IN00695388 ►Number of BMUs with functioning TB Smear microscopy (NCD) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 12.00 16.00 7.00 20.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 1 out of 15 health facilities in NCD is closed: Kilakila H/C (to be renovated). Taurama Barracks H/C was closed by Ministry of Defense for about 4 months and reopened only in December 2018. The 7 Comments: BMUs/health facilities with smear microscopy include PGMG, Gerehu, 6 Mile, Lawes Rd, 9 Mile, Badili and Tokarara. IN00695391 ►Number of BMUs with functioning Xpert MTB/Rif (NCD) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 6.00 3.00 16.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 Previously provided data has been corrected/ updated. Comments: IN00695400 ►Number of BMUs with functioning TB Smear microscopy (Daru/ South Fly District, Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 -- 1.00 2.00 Date 31-Aug-2016 -- 31-Dec-2018 30-Jun-2022 IN00695401 ►Number of BMUs with functioning Xpert MTB/Rif (Daru/ South Fly District, Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 -- 1.00 2.00 Date 31-Aug-2016 -- 31-Dec-2018 30-Jun-2022 Effective treatment of drug-susceptible and drug-resistant tuberculosis patients IN00695386 ►Smear conversion rate among DS TB cases (by 2 months for new cases and 3 months for retreatment cases) (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 73.00 76.00 73.00 85.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 5/3/2019 Page 5 of 9 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Smear conversion rate for new cases is 73% in 2018. This figure represents 2 months conversion for all DS-TB cases in NCD, as 3 months conversion for retreatment cases is no longer used due to changes in Comments: the national TB guidelines. IN00695389 ►Smear conversion rate among DS TB cases (by 2 months for new cases and 3 months for retreatment cases) (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 81.00 78.00 85.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 Smear conversion rate for new cases is 78% in 2018. This figure represents 2 months conversion for all DS-TB cases in Daru as 3 months conversion for retreatment cases is no longer used due to changes in Comments: the national TB guidelines. IN00695392 ►Culture conversion rate among DR TB cases (At 6 months for normal course and 4 months for shorter course) (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 87.50 75.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 IN00695394 ►Culture conversion rate among DR TB cases (At 6 months for normal course and 4 months for shorter course) (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.00 0.00 0.00 75.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 No update available. Comments: IN00695396 ►A reduction in lost to follow up of DS TB patients (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 15.00 6.00 2.00 6.00 Date 31-Aug-2016 31-May-2019 31-Dec-2018 30-Jun-2022 IN00695397 ►A reduction in lost to follow up of DR TB patients (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 12.00 21.00 18.00 5.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 It should be noted that the NCD TB Strategic Plan 2016-2020 reports LTFU in 2014 as 32%, which is Comments: considerably higher than the baseline recorded above. IN00695398 ►A reduction in lost to follow up of DS TB patients (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 5/3/2019 Page 6 of 9 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Value 10.00 21.00 13.00 4.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 The NCD TB Strategic Plan 2016-2020 reports Loss to Follow Up in 2014 as 32%, which is considerably Comments: higher than the baseline recorded above. IN00695399 ►Number (cumulative) of DR TB patients on shorter regimen (NCD & Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 59.00 87.00 400.00 Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 Recording and reporting on DR TB in NCD started in 2017. The shorter regimen was only introduced in 2017. Therefore, the baseline is 0. A total of 66 DR-TB patients started on a shorter regimen in 2018: 53 at Port Moresby General Hospital and 13 at Gerehu Hospital. Comments: The shorter regimen was introduced in 2017 in Daru. A total of 21 DR-TB patients started on shorter regimen in Daru (the only BMU in South Fly District). Strengthening government systems for managing its health services delivery and tuberculosis response IN00695387 ►The conduction of semi-annual review meeting which involves TB development partners and government agencies to review the progress and make the consolidated, integrated work plan and budget (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 The last semi-annual review meeting took place in October 2018. The next review is in July 2019. ERT implementation coordination group (NDOH & partners meeting was held in January 2019. The NCD 4th Comments: quarter 2018 review meeting was held in February 2019. IN00695390 ►Citizens and/or communities involved in planning/implementation/evaluation of development programs (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 Citizens/communities have been involved in planning and implementation of the project. Evaluation of the project was done through quarterly review meetings and mainly involving NCD health, NDOH and Comments: partners. Communities will be involved in project evaluation in the future. IN00695393 ►Project-supported organization(s) publishing reports containing information on feedback received from citizens and/or communities and if/how this feedback has been used (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 Interviews were done in the communities during the provision of DOTS and information shared internally. Comments: Some organizations have documented community perceptions/views in quarterly bulletins, donor reports, 5/3/2019 Page 7 of 9 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) and country human impact reports and feedback used to improve service delivery. Publication of information containing community feedback on the project will be considered from now onward. IN00695395 ►Timely delivery of annual report compiled by NTP (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 31-Aug-2016 31-May-2018 31-Dec-2018 30-Jun-2022 2018 NTP Annual TB Report is available in draft and was circulated to members of the TB technical working group for comments, and will be submitted to the senior management of NDOH for endorsement. Comments: The final report will be available in 2nd quarter of 2019. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P160947 IDA-60670 Effective USD 15.00 15.00 0.00 1.47 13.88 9.6% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P160947 IDA-60670 Effective 31-May-2017 19-Jul-2017 25-Sep-2017 30-Jun-2022 30-Jun-2022 Cumulative Disbursements 5/3/2019 Page 8 of 9 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 5/3/2019 Page 9 of 9