The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) EAST ASIA AND PACIFIC | Cambodia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2016 | Seq No: 5 | ARCHIVED on 21-Feb-2019 | ISR34208 | Implementing Agencies: Ministry of Health, Kingdom of Cambodia, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 19-May-2016 Effectiveness Date: 15-Sep-2016 Planned Mid Term Review Date: 29-Apr-2019 Actual Mid-Term Review Date: -- Original Closing Date: 30-Jun-2021 Revised Closing Date: 30-Jun-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To improve access to quality health services for the targeted population groups with protection against impoverishment due to the cost of health services in the Kingdom of Cambodia. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) To improve access to quality health services for the targeted population groups, with protection against impoverishment due to the cost of health services in the Kingdom of Cambodia, and to provide immediate and effective response in case of an eligible crisis or emergency. Components Table Name Component 1: Strengthening Health Service Delivery:(Cost $74.20 M) Component 2: Improving Financial Protection and Equity:(Cost $70.00 M) Component 3: Ensuring Sustainable and Responsive Health Systems:(Cost $36.00 M) Component 4: Contingent Emergency Response Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions 3/6/2019 Page 1 of 9 The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Project implementation is progressing well despite some initial delays in key interventions such as the roll out of quality assessment. Lump sum grants financed by the Royal government of Cambodia and performance-based grants are flowing to the health facilities on time. SDG phase 2 was rolled out in October 2018 and SDG phase 3 roll out is expected in July 2019. Six rounds of ex-ante assessment have been carried out on a quarterly basis, and being counter verified by an independent agency, GFA. The ex-post verification role is expected to be handed over to PCA by April 2019. Payment of the Health Equity Fund (HEF) is on time, and the HEF monitoring role was successfully taken over by the Payment Certification Agency in July 2018. Contracts for the construction of the 45 health centers have been awarded in mid-January 2019, and procurements of the 15 maternity ward construction are on going and expected to be completed by end of March 2019. The firm to support the design and drawings of the two provincial hospitals and civil work supervision is expected to be on board by end of February 2019. Additional Financing has been approved. Signing and effectiveness of Financing Agreement/Grant Agreement amendment letters is expected within the next few days. The AF expands the scope of the project and its development impact by adding three new DLIs focusing on NCDs and long term family planning, and taking the opportunity to restructure some of the indicators and DLI definitions/targets to address some of the implementation constraints observed in the initial stages of the project. 3/6/2019 Page 2 of 9 The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) 3/6/2019 Page 3 of 9 The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Moderate Substantial Substantial Sector Strategies and Policies Moderate Substantial Substantial Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Sustainability Substantial Substantial Substantial 3/6/2019 Page 4 of 9 The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Fiduciary High Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Moderate Substantial Substantial Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improve access to quality health services IN00660055 ►Increase in the number of health centers exceeding 60% score on the quality assessment of health facilities. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 49.00 392.00 442.00 700.00 Date 30-Apr-2016 24-Apr-2018 17-Dec-2018 30-Jun-2021 Notes: Out of 1,191 targeted HCs, 802 HCs were assessed in Q4 2018 (included 347 HCs in Phase II roll- out). Among those assessed, 442 HCs exceeded 60% scores. Comments: Source: MoH validated data in Round 6, Q4 2018. Improve financial protection and equity IN00660071 ►Reduction in the share of households that experienced impoverishing health spending during the year. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.90 -- 0.40 0.70 Date 30-Oct-2015 -- 15-Jan-2019 30-Jun-2021 Notes: These are internal estimates using CSES 2017 data and currently under validation. The methodology used for these estimates was using the national poverty line, and using a methodology consistent with the baseline estimate. Comments: Source: Cambodia Socio-Economic Survey (2014 for baseline, 2017 for current values) IN00660074 ►Reduction in out of pocket health expenditure as percentage of the total health expenditure. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.30 -- 60.40 55.00 Date 30-Oct-2015 -- 15-Jan-2019 30-Jun-2021 Notes: Data is taken from the draft version of Cambodia NHA (2012-2016) reported in November 2018. Comments: This is subject to validation of data, and information will be updated accordingly. IN00660077 3/6/2019 Page 5 of 9 The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) ►Increase in the number of outpatient services (episodes) covered by HEF (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2,474,350.00 -- 2,474,350.00 3,100,000.00 Date 30-Apr-2018 -- 15-Jan-2019 30-Jun-2021 Notes: This is a new PDO indicator revised from “Increase in utilization of health services by HEF beneficiary (Percentage)” in the recent restructuring, hence the baseline is for 2017 rather than for an earlier period. The baseline data has been updated from the approved project paper, to reflect the accurate values as per National Health Congress Report (March 2018). Comments: The data is based on National Health Congress Report (dated March 2018) based on data for the full calendar year 2017. The data for calendar year 2018 will be available in the next National Health Congress report being published in March 2019 and will be updated in the next ISR. Intermediate Results Indicators by Components Strengthening Health Service Delivery IN00660053 ►Percentage of health center, CPA-1, CPA-2, and CPA-3 facilities that receive payments based on performance that includes quality scores within 90 days of the end of the quarter. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 70.00 Date 30-Oct-2015 24-Apr-2018 19-Dec-2018 30-Jun-2021 Comments: This is based on administrative information received from DBF. Comments: IN00660072 ►Reduction in the variance in score on Health Center quality assessment. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 87.03 percentage 43 percentage points Value 53 percentage points 60.65% points Date 30-Oct-2015 24-Apr-2018 17-Dec-2018 30-Jun-2021 Notes: The highest score was 96.88% in Chob Veari HC, Preahnet Preah OD/BMC province, and the lowest score was 9.85% in Akphivoadth HC in Kampong Chhnang OD. The variance is: 96.88% - 9.85% = 87%. It should be noted that this lowest scored HC is in the phase II roll-out assessment for round 6 in Q4, Comments: 2018 Source: MoH validated data in Round 6, Q4 2018 Quality Assessment. IN00660075 ►Percentage of CPA-1, CPA-2 and CPA-3 facilities having a 60% quality score in the previous quality assessments. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 59.5% 52.63% Baseline +50% Date 30-Oct-2015 24-Apr-2018 17-Dec-2018 30-Jun-2021 Notes: Among 76 CPA1, CPA2 and CPA3 Hospitals (including 33 hospitals in phase II assessed in Q4, Comments: 2018), 52.63% of them (or 40 hospitals) had 60% scores. 3/6/2019 Page 6 of 9 The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Source: MoH validated data in Round 6, Q4 2018 Quality Assessment. Improving Financial Protection and Equity IN00660054 ►Number of operational districts reporting an increase of over 10 percent in current LTFP service users over the previous 12 months (DLI 9) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target TBD (based on DLI submission expected in next DLI report) Source: 20% increase over Value NA TBC based on HMIS baseline (disaggregated by contraception method) Date 23-Apr-2018 31-May-2018 15-Jan-2019 30-Jun-2021 Note: Baseline data will be made available as part of the next DLI report, as this is a new DLI indicator Comments: introduced with the AF. Date for baseline data is "TBD". Ensuring Sustainable and Responsive Health Systems IN00660073 ►Number of women screened for cervical cancer screening with VIA (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 37,267.00 37,267.00 37,267.00 130,000.00 Date 30-Apr-2018 30-Apr-2018 15-Jan-2019 30-Jun-2021 Note: The data is based on National Health Congress Report (published in March 2018) reporting data for calendar year 2017. The data for calendar year 2018 will be available in National Health Congress Comments: report in March 2019 and will be updated in the next ISR. IN00660076 ►Percentage of health centers, hospitals and OD/PHD receiving HEF and SDG payments within specified timelines (DLI 6). (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 80.00 Date 30-Oct-2015 24-Apr-2018 19-Dec-2018 30-Jun-2021 IN00660078 ►Number of University of Health Sciences courses that adopt competency-based curricula with trained faculty and use of skills laboratory (DLI 1). (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 25.00 Date 30-Jul-2016 01-Jul-2018 15-Jan-2019 30-Jun-2021 Notes: No further increase has been possible so far. Progress towards achieving Year 2 Targets is being made (5 more courses are expected to be reported in the upcoming DLI report). Comments: Source: Report of Verification Mission for Year 2 DLIs, October 2018 after independent verification discussions with UHS on upcoming DLI report. IN00660079 3/6/2019 Page 7 of 9 The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) ►Outpatient Department (OPD) consultations (new cases only) per person per year. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.59 0.71 0.71 0.95 Date 30-Oct-2015 24-Apr-2018 15-Jan-2019 30-Jun-2021 Note: The data is based on National Health Congress Report (published in March 2018) for calendar year 2017. The data for calendar year 2018 will be available in National Health Congress report in March Comments: 2019 and will be updated in the next ISR. IN00660080 ►Proportion of health centers with functioning health center management committees. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 64% 75% 75% Baseline + 25% Date 24-Mar-2017 24-Apr-2018 15-Jan-2019 30-Jun-2021 Note: The data is based on National Health Congress Report (published in March 2018) for 2017 calendar year. The data for 2018 calendar year will be available in National Health Congress report in Comments: March 2019 and will be updated in the next ISR. IN00660081 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 13,221,685.00 13,221,685.00 13,221,685.00 16,000,000.00 Date 01-Jan-2018 30-Apr-2018 15-Jan-2019 30-Jun-2021 Note: The data is based on National Health Congress Report (published in March 2018) for 2017 calendar year. The data for 2018 calendar year will be available in National Health Congress report in Comments: March 2019 and will be updated in the next ISR. This value is derived from the total number of outpatient department cases and inpatient department cases for all over Cambodia in calendar year 2017. IN00660082 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 7,800,000.00 7,800,000.00 7,800,000.00 9,600,000.00 Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P157291 IDA-58130 Effective USD 30.00 30.00 0.00 9.46 20.62 31% 3/6/2019 Page 8 of 9 The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) P157291 TF-A2562 Effective USD 1.00 1.00 0.00 0.24 0.76 24% P157291 TF-A3114 Effective USD 20.00 20.00 0.00 15.76 4.24 79% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P157291 IDA-58130 Effective 19-May-2016 26-Aug-2016 09-Nov-2016 30-Jun-2021 30-Jun-2021 P157291 TF-A2562 Effective 19-May-2016 15-Sep-2016 15-Sep-2016 30-Jun-2020 30-Jun-2020 P157291 TF-A3114 Effective 19-May-2016 26-Aug-2016 09-Nov-2016 30-Jun-2021 30-Jun-2021 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) P167351-Additional Financing for Health Equity and Quality Improvement Project (H-EQIP) 3/6/2019 Page 9 of 9