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: 6 | ARCHIVED on 04-Nov-2019 | ISR38615 | 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 Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating High High Implementation Status and Key Decisions Implementation continues to progress well on all Project components: Following the completion of the systemic population screening of the population for TB in Daru island, Western Province, the mop-up screening for TB in Daru, intended to screen eligible individuals who previously refused to be screened, was completed by the end of March 2019. All the TB cases identified through the screening have been placed on treatment. A final report will be completed by the end of calendar year 2019. Lessons learned from the systematic screening for TB in Daru island will inform a systematic TB screening exercise in the National Capital District (NCD) to be implemented early in calendar year 2020. In addition to procuring two ‘find and treat’ mobile vans equipped with digital X-rays to enable systematic TB screening in NCD, the Project has also procured 14 GeneXpert machines for TB diagnostics in NCD and is financing two laboratory personnel to build in-country diagnostic capacity in the Central Public Health 11/4/2019 Page 1 of 10 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Laboratory, the national reference laboratory. Technical support provided with Project financing in partnership with WHO has included updates to TB treatment guidelines as well as monitoring and technical supportive supervision to 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 Moderate Moderate Stakeholders Substantial Substantial Substantial Other -- High 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 IN00745949 ►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 6,783.00 6,783.00 7,100.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 In Q1-Q2 2019, a total of 3,607 TB patients (3,399 DS-TB and 208 DR-TB) enrolled in treatment in and all 14 BMUs reported during the period. It is expected that the number of new TB cases identified will Comments: increase in Q3-4 2019, following the procurement of additional GeneXpert machines planned for distribution in NCD. IN00745950 ►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 11/4/2019 Page 2 of 10 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Value 1,659.00 551.00 551.00 1,900.00 Date 31-Aug-2016 31-Dec-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 BMU in South Fly District. Note: It is not clear how the original baseline for Daru was determined. It could have been a typo? (1,659 instead of 659?). The total number of TB patients registered in Daru did not exceed 661 in any given year Comments: since 2012 (513 (2012), 601 (2013), 661 (2014), 498 (2015): 480 (2016). The proposed baseline of 480 TB cases is derived from 2016 case notification reports after the national emergency was declared in 2014. The proposed target for 2022 would be 612 with the assumption that the TB prevalence in Daru is 3% in a population of 18,854 (SSI, 2018) with an annual population growth is 2%. NB: different methods can be used to estimate the target IN00745981 ►The proportion of TB patients who have received drug-sensitivity testing (DST) (NCD) for Longer regime (LR) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 23.00 23.00 80.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 In Q1-2 2019, 27% of DR-TB patients (shorter regimen) received DST and 69% (longer regimen) received DST. data Comments: IN00745982 ►The proportion of TB patients who have received DST (Daru/South Fly District,Western Province) for Shorter regime (SR) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 41.00 71.00 71.00 80.00 Date 31-Aug-2016 31-Dec-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. IN00745983 ►TB treatment success rate for DS TB (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 56.00 78.00 78.00 85.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 Treatment success rate (cured & treatment completed) is 82% in Q1 2019 and 87% in Q2 2019 for DS-TB pts (2017 cohort). Q2 2019 treatment success rate exceeded the WHO recommendation of 85%. Data Comments: needs to be verified IN00745984 ►TB treatment success rate for DS TB (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/4/2019 Page 3 of 10 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Value 71.00 86.00 86.00 85.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 The treatment success rate for DS TB for the Q3+4 cohort of 2017 was 85.5%. For the Q1+2 cohort of 2018, preliminary treatment success rate is 84.2% (some patients still on treatment). Data needs to be Comments: verified IN00745985 ►TB treatment success rate for DR TB (NCD) for Shorter regime ( SR) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 44.00 64.00 64.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 Treatment success rate for DR-TB is 49% (30/62) - 2017 cohort on shorter regimen. Comments: Treatment success rate for DR-TB is 62% (70/113) - 2016 cohort on longer regimen. . IN00745986 ►TB treatment success rate for DR TB for females (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 61.00 61.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 31-Dec-2021 Data for indicator POI 4b is not routinely collected and has to be collected separately from the TB Register Comments: at the facilities registering DR TB patients. Efforts are currently underway to disintegrate data by gender.. IN00745987 ►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 87.00 87.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 The treatment success rate for the Q1-2 cohort of 2017 was 94.6%, compared to 92% for the Q3+4 cohort Comments: of 2016. IN00745988 ►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-Dec-2018 31-Dec-2018 30-Jun-2022 Data for indicator POI 4b is not routinely collected and has to be collected separately from the TB Register at the facilities registering DR TB patients. Efforts are currently underway to disintegrate data by gender. Comments: Data is not available at the moment .. IN00745989 ►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 11/4/2019 Page 4 of 10 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Value 0.00 16.00 16.00 20.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 A total of 54 health workers trained/retrained on TB management from 14 BMUs in NCD including staff Comments: members of NCD Health. Overall Comments PDO Data to be updated in the next ISR when National TB program data for January to December 2019 are released. Intermediate Results Indicators by Components Early detection of active tuberculosis patients IN00745990 ►Population-based screening in Daru is complete (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 The systematic screening initiative (SSI) for active TB case finding was completed on 31 March 2019, following a mop-up screening. Preliminary data analysis was done and the final data analysis and report writing are ongoing. The final report will be available by the end of Q3 or early in Q4 2019. A dissemination workshop is planned for Q4 2019. The preliminary results showed:  Successful SSI implementation reached 83% (13,037) of eligible populations and yielded 64 Comments: bacteriologically-confirmed cases (700 per 100 000 population).  8,910 (68%) were successfully enrolled in SSI.  The participation rate and % of x-ray higher score and yield varied across four wards. There may be a missed opportunity for detecting possible more cases in IARU ward where participation rate was low but % yield was the highest. IN00745993 ►Number of BMUs with functioning TB Smear microscopy (NCD) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7.00 7.00 7.00 14.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 Seven out of 14 BMUs in NCD have functioning TB smear microscopy and they include; PMGH, Gerehu Comments: hospital, 6 Mile, Lawes Rd, 9 Mile, Badili and Tokarara. IN00745996 ►Number of BMUs with functioning Xpert MTB/Rif (NCD) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 3.00 3.00 14.00 11/4/2019 Page 5 of 10 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 By the end of June 2019, three BMUs (Gerehu hospital, PMGH, and 6 Mile) out of 14 BMUs in NCD had a functioning GeneXpert MTB/RIF. In Q3-4 2019, five additional BMUs (Lawes Rd, Badili, Kaugere, 9 Mile Comments: and Tokorara) will be equipped with GeneXpert MTB/RIF. IN00745999 ►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 1.00 2.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 Daru is the only diagnostic and therapeutic facility in the South Fly District of Western Province while Mabudawan is a health post (used for continuation of TB treatment; however, it does not have a Comments: functioning TB smear microscopy or GeneXpert MTB/RIF). IN00746002 ►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 1.00 2.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 Daru General Hospital is the only BMU with functioning GeneXpert machine in the South Fly District of Comments: Western Province. Effective treatment of drug-susceptible and drug-resistant tuberculosis patients IN00745991 ►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 73.00 73.00 85.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 The sputum smear conversion rate for DS-TB cases was 83% in Q1 2019 and 93% in Q2 2019.Note: 3- months conversion for retreatment cases is no longer used due to changes in the national TB guidelines. Comments: . IN00745994 ►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 78.00 78.00 85.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 Data not available at the moment. Note: 3-months conversion for retreatment cases is no longer used Comments: due to changes in the national TB guidelines IN00745997 ►Culture conversion rate among DR TB cases ( 4 months for shorter course) (NCD) for Shorter Regime (SR) (Percentage, Custom) 11/4/2019 Page 6 of 10 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 87.50 87.50 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 IN00746000 ►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-Dec-2018 31-Dec-2018 30-Jun-2022 No update available. Comments: IN00746003 ►Percentage of 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 2.00 2.00 6.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 The Q1+2 of 2018 cohort showed a LTFU rate of 4.5% for DS TB patients (compared to 1.8% LTFU for Comments: Q3+4 cohort of 2017) IN00746004 ►Percentage of Lost to follow up of DR TB patients (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 12.00 18.00 18.00 5.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 In Q1-2 2019, 12% (35/285) of DR-TB patients enrolled in treatment were LTFU in both Gerehu hospital Comments: and PMGH. IN00746005 ►A reduction in lost to follow up of DS TB patients (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 13.00 13.00 4.00 Date 31-Aug-2016 31-Dec-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. IN00746006 ►Number (cumulative) of DR TB patients on shorter regimen (NCD & Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 87.00 87.00 400.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 11/4/2019 Page 7 of 10 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) 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 IN00745992 ►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-Dec-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. IN00745995 ►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-Dec-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. IN00745998 ►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-Dec-2018 31-Dec-2018 30-Jun-2022 Interviews were done in the communities during the provision of DOTS and information shared internally. Some organizations have documented community perceptions/views in quarterly bulletins, donor reports, Comments: 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. IN00746001 ►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-Dec-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. 11/4/2019 Page 8 of 10 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Overall Comments IR Data to be updated in the next ISR when National TB program data for January to December 2019 are released. 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 3.76 11.55 25% 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 11/4/2019 Page 9 of 10 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. 11/4/2019 Page 10 of 10