Public Disclosure Copy The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) Uttarakhand Health Systems Development Project (P148531) SOUTH ASIA | India | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 2 | ARCHIVED on 08-Dec-2017 | ISR30362 | Implementing Agencies: Government of India, Department of Medical Health and Family Welfare, Government of Uttarakhand Key Dates Key Project Dates Bank Approval Date:26-Jan-2017 Effectiveness Date:23-May-2017 Planned Mid Term Review Date:06-Apr-2020 Actual Mid-Term Review Date:-- Original Closing Date:30-Sep-2023 Revised Closing Date:30-Sep-2023 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to improve access to quality health services, particularly in the hilly districts of thestate, and to expand health financial risk protection for the residents of Uttarakhand Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Innovations in engaging the private sector:(Cost $80.00 M) Stewardship and system improvement component:(Cost $45.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Satisfactory  Moderately Satisfactory Overall Risk Rating  Substantial  Substantial Implementation Status and Key Decisions 12/8/2017 Page 1 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) The legal agreement for the Uttarakhand Health Systems Development Project was signed between the World Bank, the Government of India and the Government of Uttarakhand on March 23, 2017 and became effective on May 23, 2017. There has been some limited progress on project interventions in the past six months. The Project Implementation Team (PIT) has initiated preparatory activities related to two critical interventions under the project: (i) NABH accreditation of 5 hospitals and (ii) support to the state in strengthening Mukhyamantri Swasthya Bima Yojna (MSBY). For NABH, a TOR has been prepared and cleared by the Bank for hiring of a firm to carry out a gap and feasibility assessment of 5 hospitals; it was discussed and agreed that the state will publish the RFP and complete the hiring process by February 15, 2018. The Bank has discussed and agreed with the state to provide broader technical assistance in strengthening and potentially restructuring the existing insurance scheme, MSBY. A preliminary review of the scheme was conducted by the Bank, and accordingly the Bank suggests assessments/reviews in several key areas including: (i) insurer and TPA performance assessment; (ii) SNA/insurance agency and insurance agency/TPA contract review; (iii) review of the packages and package rates; (iv) enrollment database review; and (v) SNA capacity assessment. The recommendation on the TPA engagement will be provided by mid-December and other assessments and reviews identified for the medium term will be initiated in discussions with the State. However, implementation challenges have resulted from the delayed establishment of the Project Governing Board and Project Steering Committee. This has led to delays in the recruitment of key positions within the PIT, establishment of functional office space, and contracting of a private provider for the Tehri cluster to kick start a major component of the Project. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  Moderate  Moderate Macroeconomic  --  Moderate  Moderate Sector Strategies and Policies  --  Moderate  Moderate Technical Design of Project or Program  --  Substantial  Substantial Institutional Capacity for Implementation and Sustainability  --  Substantial  Substantial Fiduciary  --  Substantial  Substantial Environment and Social  --  Low  Moderate Stakeholders  --  Substantial  Substantial Other  --  --  -- Overall  --  Substantial  Substantial Results Project Development Objective Indicators PHINDPDOTBL  Number of outpatient visits to Primary Health Centers (PHCs), CHCs, and mobile vans per year, disaggregated by districts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/8/2017 Page 2 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) Value 774,926.00 -- -- 1,150,000.00 Date 31-Mar-2016 -- -- 31-Mar-2023 PHINDPDOTBL  Number of persons who used the Health Helpline to receive information or lodge grievances, disaggregated by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 81,192.00 -- -- 160,000.00 Date 25-Nov-2016 -- -- 31-Mar-2023 PHINDPDOTBL  Patients contacted by the Health Helpline that are satisfied with the health services provided to them (per year, disaggregated by gender) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- 70.00 Date 25-Nov-2016 -- -- 31-Mar-2023 PHINDPDOTBL  Number of government and non-government healthcare facilities in the state issued with an entry (or higher) level certification by the National Accreditation Board for Hospitals (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 -- -- 8.00 Date 25-Nov-2016 -- -- 31-Mar-2023 PHINDPDOTBL  Number of hospital admissions and outpatient consultations covered by any form of health insurance supported by the project (RSBY and MSBY), disaggregated by gender (Number, Custom) 12/8/2017 Page 3 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) Baseline Actual (Previous) Actual (Current) End Target Value 46,040.00 -- -- 100,000.00 Date 29-Jul-2016 -- -- 31-Mar-2023 Overall Comments Intermediate Results Indicators PHINDIRITBL  People with access to any form of health insurance in the state during the year, disaggregated by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 921,584.00 -- -- 3,000,000.00 Date 31-Dec-2014 -- -- 31-Mar-2023 PHINDIRITBL  Number of children covered under the expanded health insurance program who received an annual health assessment during the year, disaggregated by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- 200,000.00 Date 25-Nov-2016 -- -- 31-Mar-2023 PHINDIRITBL  Number of children immunized during the year (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 140,631.00 -- -- 180,000.00 Date 31-Mar-2016 -- -- 31-Mar-2023 12/8/2017 Page 4 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) PHINDIRITBL  Number of patients who use the services provided by the mobile health vans, disaggregated by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 104,122.00 -- -- 300,000.00 Date 25-Nov-2016 -- -- 31-Mar-2023 PHINDIRITBL  Number of mobile medical units complying with the requirement of having at least one female doctor with sonology certification (>90% compliance on a day-to-day basis) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- 9.00 Date 25-Nov-2016 -- -- 31-Mar-2023 PHINDIRITBL  Number of outsourced CHCs with utilization of emergency services reported during each month (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- 8.00 Date 25-Nov-2016 -- -- 31-Mar-2023 PHINDIRITBL  Number of outsourced CHCs where at least one emergency caesarean section was reported during each quarter (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- 6.00 Date 25-Nov-2016 -- -- 31-Mar-2023 12/8/2017 Page 5 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) PHINDIRITBL  Benefit package of child health services finalized and piloted (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 'yes' from year Value 0.00 -- -- 2 Date 25-Nov-2016 -- -- 31-Mar-2023 PHINDIRITBL  Benefit package of NCDs services finalized and piloted (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target "no" for the first three years and Value 0.00 -- -- "yes" from year 4. Date 25-Nov-2016 -- -- 31-Mar-2023 PHINDIRITBL  Share of eligible households successfully enrolled under RSBY/MSBY during the year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.70 -- -- 50.00 Date 31-Dec-2014 -- -- 31-Mar-2023 PHINDIRITBL  Number of specialists working in the outsourced health facilities (and augmenting the positions functionally vacant in the public system) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 25.00 -- -- 50.00 Date 25-Nov-2016 -- -- 31-Mar-2023 12/8/2017 Page 6 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) PHINDIRITBL  Health personnel receiving training financed by the project- cumulative (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- 5,000.00 Date 25-Nov-2016 -- -- 31-Mar-2023 PHINDIRITBL  Development and periodical update of a comprehensive disaster response plan at the state level (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Done by year 2, updated by Value 0.00 -- -- year revised by year 6. Date 25-Nov-2016 -- -- 31-Mar-2023 Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P148531 IDA-59480 Effective USD 100.00 100.00 0.00 0.05 99.95 0% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P148531 IDA-59480 Effective 26-Jan-2017 23-Mar-2017 23-May-2017 30-Sep-2023 30-Sep-2023 Cumulative Disbursements 12/8/2017 Page 7 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Uttarakhand Health Systems Development Project (P148531) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 12/8/2017 Page 8 of 8 Public Disclosure Copy