The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) Health Equity and Quality Improvement Project - Phase 2 (P173368) EAST ASIA AND PACIFIC | Cambodia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2022 | Seq No: 1 | ARCHIVED on 20-Jun-2022 | ISR51646 | Implementing Agencies: Kingdom of Cambodia, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 10-Mar-2022 Effectiveness Date: -- Planned Mid Term Review Date: 11-Nov-2024 Actual Mid-Term Review Date: Original Closing Date: 31-Dec-2027 Revised Closing Date: 31-Dec-2027 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The PDO is to improve equitable utilization of quality health services in Cambodia, especially for the poor and vulnerable populations, and to provide immediate and effective response in case of an Eligible Crisis or Emergency in the Kingdom of Cambodia. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Improving Financial Protection and Utilization of Health Equity Fund:(Cost $112.00 M) Component 2: Strengthening Quality and Capacity of Health Service Delivery:(Cost $183.30 M) Component 3: Project Management, Monitoring & Evaluation, Gender Equality and Social Inclusion:(Cost $3.70 M) Component 4: Contingent Emergency Response Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO -- Satisfactory Overall Implementation Progress (IP) -- Satisfactory Overall Risk Rating -- Substantial Implementation Status and Key Decisions Project effectiveness: The Health Equity and Quality Improvement Project - Phase 2 (H-EQIP II) was approved on March 10, 2022. The project is expected to become effective in early July. The Administrative Agreement for the Multi-donor Trust Fund (MDTF) to receive the contribution from German Development Bank (KfW) and Korea International Cooperation Agency (KOICA) is expected to be signed by the end of July 2022. The implementation is expected to commence in July, 2022 to ensure the continuity of funds being provided to the major health sector program, such as Service Delivery Grants and Health Equity Fund, as the funds for these programs under HEQIP phase I have been fully used. The remaining step to meet the effectiveness condition is the adoption of POM. The World Bank team has been working closely with the government to provide support as needed in developing and finalizing the POM. The Bank and the pooled-fund partners have provided comments back to the 6/20/2022 Page 1 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) government to the draft POM and in turn the draft POM and all the annexes have been submitted to the Ministry of Economy and Finance for review and clearance on June 13th before submitting to the Bank for final approval. Preparing for project implementation: To prepare for the project implementation, the government has taken actions to build the governance system. Project director, project manager, technical leads and technical focal points from relevant departments have been appointed, with their roles and responsibilities clearly defined. The new mechanism also consolidates the project implementation management of a few ongoing World Bank health projects in Cambodia through appointing the same director and the same manager across the projects. This change is expected to bring in increased efficiency and synergy among different health projects. 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 Moderate -- Moderate Institutional Capacity for Implementation and Substantial -- Substantial Sustainability Fiduciary Substantial -- Substantial Environment and Social Substantial -- Substantial Stakeholders Moderate -- Moderate Other Moderate -- Moderate Overall Substantial -- Substantial Results PDO Indicators by Objectives / Outcomes Improved equitable utilization of health services IN01147540 ►1. Outpatient visits by HEF beneficiaries in low utilization ODs (Text, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.44 -- 0.44 0.78 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147543 6/20/2022 Page 2 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) 1.1. Outpatient visits by HEF beneficiaries in select provinces with highest multidimensional poverty (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.59 -- 0.59 0.93 IN01147544 1.2. Outpatient visits by female HEF beneficiaries in low utilization ODs (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Full-year utilization of Full-year utilization of female beneficiaries in female beneficiaries in project year 3 for these project year 3 for these ODs will be the ODs will be the baseline, Baseline plus 0.16 per Value -- baseline, to be reported to be reported at the end capita per year at the end of year 3 of year 3 after the full after the full PMRS has PMRS has been rolled been rolled out out nationwide. nationwide. IN01147546 1.3. Outpatient visits by male HEF beneficiaries in low utilization ODs (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Full-year utilization of Full-year utilization of male beneficiaries in male beneficiaries in project year 3 will be the project year 3 will be the baseline, to be reported Baseline plus 0.16 per Value baseline, to be reported -- at the end of year 3 capita per year at the end of year 3 after after the full PMRS has the full PMRS has been been rolled out rolled out nationwide. nationwide. IN01147548 ►2.1. Percentage of HEF beneficiaries in all HCs with Full PMRS being introduced in year 1, used the outpatient service paid by HEF (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Full-year utilization of male beneficiaries in Full-year utilization of project year 3 will be project year 2 will be the the baseline, to be 15 percentage point Value -- baseline to be reported in reported at the end of increase from baseline the end of year 2. year 3 after the full PMRS has been rolled out nationwide. Date 30-Jun-2022 -- 31-May-2022 30-Jun-2027 IN01147550 2.1.1. Percentage of female HEF beneficiaries, in all HC with Full PMRS being introduced in year 1, used the outpatient service paid by HEF (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Full-year utilization of Full-year utilization of female beneficiaries in female beneficiaries in 15 percentage point Value project year 2 will be the -- project year 2 will be the increase from baseline baseline to be reported at baseline to be reported the end of year 2. at the end of year 2. IN01147551 2.1.2. Percentage of male HEF beneficiaries, in all HC with Full PMRS being introduced in year 1, used the outpatient service paid by HEF (Text, Custom Supplement) 6/20/2022 Page 3 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) Baseline Actual (Previous) Actual (Current) End Target Full-year utilization of Full-year utilization of male beneficiaries in male beneficiaries in 15 percentage point Value project year 2 will be the -- project year 2 will be the increase from baseline baseline to be reported at baseline to be reported the end of year 2. at the end of year 2. IN01147552 ►2.2. Percentage of HEF beneficiaries in all HCs with Full PMRS being introduced in year 2, used the outpatient service paid by HEF (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Full year utilization of Full year utilization of project year 3 will be project year 3 will be the 10 percentage point Value -- the baseline to be baseline to be reported in increase from baseline reported in the end of the end of year 3. year 3. Date 30-Jun-2025 -- 31-May-2022 25-Jun-2027 IN01147553 2.2.1 Percentage of female HEF beneficiaries, in all HC with Full PMRS being introduced in year 2, used the outpatient service paid by HEF (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Full-year utilization for Full-year utilization for female beneficiaries in female beneficiaries in 10 percentage point Value project year 3 will be the -- project year 3 will be the increase from baseline baseline to be reported at baseline to be reported the end of year 3. at the end of year 3. IN01147554 2.2.2. Percentage of male HEF beneficiaries in all HCs with Full PMRS being introduced in year 2, used the outpatient service paid by HEF (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Full-year utilization for Full-year utilization for male beneficiaries in male beneficiaries in 10 percentage point Value project year 3 will be the -- project year 3 will be the increase from baseline baseline to be reported at baseline to be reported the end of year 3. at the end of year 3. IN01147555 ►2.3. Percentage of HEF beneficiaries in all HCs with Full PMRS being introduced in year 3, used the outpatient service paid by HEF (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Full year utilization of Full year utilization of project year 3 will be project year 3 will be the 5 percentage point Value -- the baseline to be baseline to be reported in increase from baseline reported in the end of the end of year 4. year 4. Date 30-Jun-2026 -- 31-May-2022 30-Jun-2027 IN01147556 2.3.1. Percentage of female HEF beneficiaries in all HCs with Full PMRS being introduced in year 3, used the outpatient service paid by HEF (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Full-year utilization of Full-year utilization of female beneficiaries in female beneficiaries in 5 percentage point Value project year 3 will be the -- project year 3 will be the increase from baseline baseline to be reported in baseline to be reported the end of year 4 in the end of year 4 6/20/2022 Page 4 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) IN01147557 2.3.2. Percentage of male HEF beneficiaries, in all HC with Full PMRS being introduced in year 3, used the outpatient service paid by HEF (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Full-year utilization of Full-year utilization of male beneficiaries in male beneficiaries in 5 percentage point Value project year 3 will be the -- project year 3 will be the increase from baseline baseline to be reported at baseline to be reported the end of year 4 at the end of year 4 Improved quality of health services utilized IN01147541 ►3. Number of HFs exceeding 60 percent score in the April-May round of semi-annual national quality assessment (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 700.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 Due to the change on government's side regarding the schedule to carry out the external assessment, it is suggested by the government that the description of this PDO indicator be updated to "Number of HFs exceeding 60 percent score in the March-May round of semi-annual national quality Comments: assessment". The external assessment by the OD and PHD assessor will start from March rather than April as previously defined to allow sufficient time for PCA to carry out the quality validation. This update has been reflected in the Project Operations Manual and will be updated in the future restructuring. IN01147542 ►4. Hypertension screening rate (Percentage, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147545 4.1. Hypertension screening rate among women (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147547 4.2. Hypertension screening rate among men (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147549 ►5. Number of HFs with Full PMRS introduced routinely collect & report sex, age & geographical location disaggregated data, gender- specific health data (e.g. GBV), & other markers of disadvantage (Number, Custom) 6/20/2022 Page 5 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 820.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 Intermediate Results Indicators by Components Component 1: Improving Financial Protection and Utilization of Health Equity Fund IN01147558 ►1. Percentage of HEF claims verified by PCA within six working days (Text, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value N/A -- N/A 100% Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147561 ►2. Percentage of NSSF invoice verified by PCA within six working days (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 100.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147564 ►3. Total number of HEF utilization (Outpatient and Inpatient visits) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3,277,126.00 -- 3,277,126.00 3,932,551.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 By May 31st, 2022, the total utilization for the year ending at June 30, 2022 is not available yet, So the Comments: current value stays as the same as the baseline, Component 2: Strengthening Quality and Capacity of Health Service Delivery IN01147560 ►4. Percent of HFs for which ex-post verification score is more than or equal to 10.5 percent point lower than ex-ante assessment score (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 Less than 15% Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147563 ►5. Cervical cancer screening rate of target population (Percentage, Custom) 6/20/2022 Page 6 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147566 ►6. Number of HCs with established electronic rosters for target population (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 500.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147568 ►7. Number of diabetes patients managed by HCs according to the national protocol (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 700.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147569 7.1. Number of female diabetes patients managed by HCs according to the national protocol (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 395.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147570 7.2. Number of male diabetes patients managed by HCs according to the national protocol (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 305.00 Date 30-Jun-2021 -- 31-May-2022 12-Nov-2027 IN01147571 ►8. Percentage of hypertension cases managed by public health facilities according to national protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 70.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147572 8.1. Percentage of hypertension cases managed by public health facilities according to the national protocol among women (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 70.00 6/20/2022 Page 7 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147573 8.2. Percentage of hypertension cases managed by public health facilities according to the national protocol among men (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 70.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147574 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 10,910,837.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147575 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 1,633,770.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147576 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 7,694,912.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147577 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 1,573,155.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 Component 3: Project Management, Monitoring & Evaluation, Gender Equality and Social Inclusion IN01147559 ►10. Percentage of HFs producing timely financial report as stipulated in the SDG Manual (Percentage, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 100.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 6/20/2022 Page 8 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) IN01147562 ►11. Number of management and health providers trained on GESI standards for health management and service delivery by province and sex. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 150 additional managers and technical staff from central level and subnational levels Value 0.00 -- 0.00 trained and Women in leadership development program conducted for at least 50 women. Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147565 ►12. Number of data reviews conducted on the utilization of essential health services including NCDs (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 2.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 IN01147567 ►13. Percentage of complaints received to the project Grievance Redress Mechanism (GRM) addressed within 60 days (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 70.00 Date 30-Jun-2021 -- 31-May-2022 30-Jun-2027 Performance-Based Conditions IN01147578 ►PBC 1 Improved HEF Management (Text, Process, 1,000,000.00, 0.00%) Year 5: Commencing January 1, 2027 and ending on June 30, Baseline Actual (Previous) Actual (Current) 2027 (a) Semi-annual workshop to review HEF utilization conducted and Value Nil -- Nil semi-annual HEF utilization analysis reports, including findings from the rapid survey, 6/20/2022 Page 9 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) completed according to the defined template by end of August (PBC Value: US$90,000) (time bound). Date -- -- 31-May-2022 -- IN01147579 ►PBC 2 Expanded PCA Functions and Service Coverage (time bound except for target c for year 1-3) (Text, Process, 6,000,000.00, 0.00%) Year 5: Commencing January 1, 2027 and ending on June 30, Baseline Actual (Previous) Actual (Current) 2027 (a) One round of ex- post verification conducted for NQEMTs-II, and verification report prepared and shared with QIWG within 45 days (Formula: US$150,000 per round; PBC Value: Value Nil -- Nil US$150,000). (b) One rounds of validation of NCD services provision conducted and report submitted within 45 days (Formula: US$310,000 per round; PBC Value: US$310,000). Date -- -- 31-May-2022 -- IN01147580 ►PBC 3 Enhanced Quality of Health Service as defined in NQEMTs-II by MOH (Text, Process, 3,800,000.00, 0.00%) Year 5: Commencing January 1, 2027 and ending on June 30, Baseline Actual (Previous) Actual (Current) 2027 Value Nil -- Nil (a) At least 700 HFs reached 70% score in round 1 (Formula: US$256,250 per round; PBC Value 6/20/2022 Page 10 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) US$256,250).(b) Less than 15 percent of HFs which ex-post verification and ex- ante assessment scores differed more than 10.5 percent point. (PBC Value: US$150,000) (time bound). Date -- -- 31-May-2022 -- The verification protocol regarding Target (c )year 1 and target (b) year 1 needs to be modified as reflected in the following: "This PBC will finance QAO’s expenditures for (a) building PHD and OD assessor teams to conduct NQEMTs-II;(b) building the capacity of HCs and PHs/RHs to improve quality of healthcare service delivery; (c) developing 40 new clinical vignettes and their respective coaching protocols, and knowledge tests to be added in implementation of NQEMTs-II for improving knowledge and competency of health facility staff; Comments: and (d) conducting supervisions as necessary to improve the implementation of NQEMTs-II as well as the performance of health facilities. Target (a) of year 1 is time bound; Target (b) of year 2-5 is time bound; target (c) of year 1 and target (c) in year 3 are scalable; target (b) of year 1 and target (a) of year 2-5 is not timebound, which means MOH can continue to implement in the following years, but the disbursement will be made only when the target has been achieved." this has been reflected in the Project Operations Manual, which will also be reflected in the future restructuring as needed. IN01147581 ►PBC 4 Rolling out of NCD Services and Cervical Cancer Screening—National (Text, Process, 2,000,000.00, 0.00%) Year 5: Commencing January 1, 2027 and ending on June 30, Baseline Actual (Previous) Actual (Current) 2027 (a) Supervision, coaching, and semi- annual reviews conducted according to the AOP (PBC Value: US$100,000) Value Nil -- Nil (time bound). (b)Health promotion activities completed according to the AOP (PBC Value: US$50,000). Date -- -- 31-May-2022 -- IN01147582 ►PBC 5 Rolling out of NCD Services and Cervical Cancer Screening – Subnational Level (scalable, non-time bound) (Text, Process, 4,700,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) Year 5: Commencing January 1, 2027 and 6/20/2022 Page 11 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) ending on June 30, 2027 (a) At least 50% of the target population screened for hypertension and diabetes (Formula: US$200 per OD; US$60 per HC; PBC Value Nil -- Nil Value: US$87,000). (b) At least 50% of the target population screened for cervical cancer (Formula: US$200 per OD; US$60 per HC; PBC Value: US$66,800). Date -- -- 31-May-2022 -- IN01147583 ►PBC 6 Timely processing of project funds and improved capacity of sub-national HFs in applying relevant financial management system (Text, Process, 600,000.00, 0.00%) Year 5: Commencing January 1, 2027 and ending on June 30, Baseline Actual (Previous) Actual (Current) 2027 (a) HEF and SDG payments processed within 5 working Value Nil -- Nil days. (PBC Value: US$17,000) (time bound). Date -- -- 31-May-2022 -- IN01147584 ►PBC 7 Implementation of Gender Equality and Social Inclusion Action Plan (scalable, non-time bound) (Text, Process, 500,000.00, 0.00%) Year 5: Commencing January 1, 2027 and ending on June 30, Baseline Actual (Previous) Actual (Current) 2027 Value Nil -- Nil Evidence informed policy roundtables held on (a) GESI and progress made toward UHC and who is left behind and (b) on a gender equal and inclusive 6/20/2022 Page 12 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) workforce (time bound) Date -- -- 31-May-2022 -- Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Not P173368 IDA-70460 USD 55.00 55.00 0.00 0.00 51.35 0% Effective Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date Not P173368 IDA-70460 10-Mar-2022 18-Apr-2022 -- 31-Dec-2027 31-Dec-2027 Effective Cumulative Disbursements 6/20/2022 Page 13 of 14 The World Bank Implementation Status & Results Report Health Equity and Quality Improvement Project - Phase 2 (P173368) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 6/20/2022 Page 14 of 14