The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) Andhra Pradesh Health Systems Strengthening Project (P167581) SOUTH ASIA | India | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2019 | Seq No: 6 | ARCHIVED on 26-Jun-2022 | ISR51032 | Implementing Agencies: Department of Health, Medical and Family Welfare, Govt. of Andhra Pradesh, Republic of India Key Dates Key Project Dates Bank Approval Date: 15-May-2019 Effectiveness Date: 09-Sep-2019 Planned Mid Term Review Date: 30-Apr-2022 Actual Mid-Term Review Date: 25-Apr-2022 Original Closing Date: 30-Sep-2024 Revised Closing Date: 30-Sep-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objectives are to improve the quality and responsiveness of public health services and increase access of the population to an expanded package of primary health services. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Improve Quality of Care:(Cost $1301.87 M) Improve Responsiveness of Public Health Services:(Cost $153.48 M) Increase Access to an Expanded Package of Primary Health Services:(Cost $1867.88 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 Moderate Moderate Implementation Status and Key Decisions The project development objective (PDO) is to improve the quality and responsiveness of public health services and increase access of the population to an expanded package of primary health care services in Andhra Pradesh. Out of the four PDO level indicators, two has surpassed their mid-term targets. Progress on remaining two indicators is on track. Progress on the 15 intermediate indicators and two sub indicators has been mixed. Seven indicators related to quality have either been achieved or surpassed as per their midterm targets. Five indicators related to access to expanded package of services are on track and remaining five indicators related to the STEPwise Approach to Non-Communicable Disease Risk Factor Surveillance (STEPS) survey, bio medical equipment maintenance and patient experience continue to make limited progress. The project has 9 Disbursement-Linked Indicators (DLIs) with 26 Disbursement-Linked Results (DLRs). So far, 12 DLRs are fully achieved, four are under progress and likely to achieve their target by end of May 2022. 6/26/2022 Page 1 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Moderate Moderate Macroeconomic Low Low Low Sector Strategies and Policies Low Low Low Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Low Low Low Sustainability Fiduciary Moderate Moderate Moderate Environment and Social Moderate Moderate Moderate Stakeholders Low Low Low Other -- -- -- Overall Moderate Moderate Moderate Results PDO Indicators by Objectives / Outcomes Improve quality of care IN01128546 ►Increase in number of CHCs and PHCs with quality certification (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 64.00 134.00 198.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 Year 5 targets have been achieved. Comments: Improve responsiveness of public health services IN01128495 ►Increase in the average patient reported experience score (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/26/2022 Page 2 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) Development of Development of the Baseline to be application to measure application to measure 5 percentage point Value established for patient patient experience in patient experience in increase from baseline reported experience process. Baseline progress. Baseline expected by Year 3. expected by Sep 2022. Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 Actual value: Development of the application to measure patient experience in progress. Baseline expected by September 2022. Comments: The tool for reporting patient experience has been finalized during the recent mission. The Comments: data for patient experience will be captured using multiple approaches such as self-administered kiosk at the health facility, manual data collection by trainee nurses as exit interview and IVRS. Increase acess to an expanded package of primary health services IN01128547 ►Increase in percentage of patients diagnosed and at risk of hypertension and diabetes, managed as per protocol at the SC or PHC (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Baseline to be Protocols have been Increase in baseline established following issued. Development of Baseline not yet Value value by 2 percentage development of clinical system to track patient established. point protocols management in process. Date 01-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 IN01128548 ►Increase in the number of districts with at least 90% of pregnant women receiving full ante-natal care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 9.00 11.00 11.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 11 districts achieved at least 90% of pregnant women receiving full antenatal care, and so Year 5 targets Comments: have been achieved. Intermediate Results Indicators by Components Improve Quality of Care IN01128549 ►Increase in the number of CHCs and PHCs with more than 70 percent quality accreditation score following the State-level internal assessment (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 190.00 254.00 390.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 Target achieved. Comments: IN01128552 6/26/2022 Page 3 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) ►Establish and operate a quality tracking dashboard covering PHC and CHC facilities for supporting quality improvement and maintenance (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Quality Tracking Quality dashboard now 100 PHC and CHC Dashboard now in place, in place, and 66 PHC No dashboard currently facilities included in Value and 28 (11 CHCs & 17 and CHC facilities exists quarterly dashboard PHCs) included in included in quarterly reports Dashboard. report Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 Target achieved. Comments: IN01128554 ►Increase in the number of CHCs covered by a core package of services contributing towards quality of care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 28.00 28.00 65.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 Target achieved. Comments: IN01128556 ►Increase in the percentage of CHCs achieving at least 90% sanitation score monthly for a period of at least six months in a year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 90.00 90.00 90.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 Year 5 target achieved. Comments: IN01128559 ►Improvement in the pharmaceutical stock management system at the PHCs and CHCs (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Existing system provides information on current System upgradation is Quarterly stock- status Quarterly stock- status stock, but has limited under the process and reports for PHCs & Value reports for PHCs and advanced functions such expected to be ready by CHCs generated CHCs generated as auto alerts indicating quarter 4. low stock Date 28-Feb-2019 17-Nov-2021 17-Nov-2021 30-Jun-2024 Year 5 target achieved. Comments: IN01128562 ►Establish a system for routine maintenance and repair for bio-medical equipment at the CHC level (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No system in place. No system in place yet. No system in place Functional System in Finalization of Terms of yet. Finalization of place Reference in process. Terms of Reference in 6/26/2022 Page 4 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) Expected to be achieved process. Expected to by March 2022. be achieved by June 2022. Date 30-Jun-2019 17-Nov-2021 29-Apr-2022 30-Jun-2022 Not yet achieved. Process under way. Comments: Improve Responsiveness of Public Health Services IN01128550 ►Increase in the number of health facilities with an operational integrated online patient management system (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1,400.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 The tool for reporting patient experience has been finalized during the recent mission. The data for patient experience will be captured using multiple approaches such as self-administered kiosk at the health Comments: facility, manual data collection by trainee nurses as exit interview and IVR. The project will start enrolling the tool in health facilities in the next fiscal year, when reporting is also expected. IN01128553 ►Increase in the percentage of patients accessing their individual EMR (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 6% increase from Value 0.00 0.00 0.00 baseline Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 Not achieved. Comments: IN01128557 ►Increase in the number of facilities where the system for measuring and reporting on patient experience is operational (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1,400.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 Not achieved. Comments: IN01128560 ►Percentage of districts organizing quarterly review meetings on patient feedback (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 Not started. Comments: 6/26/2022 Page 5 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) Increase Access to an Expanded Package of Primary Health Services IN01128551 ►Increase in the number of functional health and wellness centres (HWCs) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 3,000.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 2889 HWCs meet 4 out of 5 criteria - all except creation of NCD patient registry Comments: IN01128555 ►Increase in the number of subcenters with trained mid-level service providers (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 300.00 2,920.00 5,156.00 5,900.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 Yearly target exceeded for this indicator. Comments: IN01128558 ►Increase in the percent of adult population screened and stratified by risk as per clinical protocols for hypertension and diabetes (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 12.00 31.00 42.94 67.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 Not achieved. Comments: IN01128561 Increase in the percent of male population screened and stratified by risk as per clinical protocols for hypertension and diabetes (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 32.00 42.96 35.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 IN01128563 Increase in the percent of female population screened and stratified by risk as per clinical protocols for hypertension and diabetes (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 23.00 31.00 42.92 70.00 Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2024 IN01128564 ►Increase in the percentage of women above age 30 years screened for cervical cancer at subcenters or PHC facilities (Percentage, Custom) 6/26/2022 Page 6 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) Baseline Actual (Previous) Actual (Current) End Target Value 26.00 26.00 50.70 70.00 Date 28-Feb-2019 30-Nov-2020 29-Apr-2022 30-Jun-2024 Not achieved, but in progress Comments: IN01128565 ►Research and evaluation undertaken to support the innovative approaches to delivery of primary health care (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Population-based survey Population-based survey Population-based of NCD risk factor of NCD risk factor survey of NCD risk prevalence not prevalence not factor prevalence not End-line study for Value undertaken and e- undertaken and e- undertaken and e- evaluation on e- subcenter model overall subcenter model overall subcenter model subcenter completed effectiveness not effectiveness not overall effectiveness evaluated evaluated not evaluated Date 28-Feb-2019 17-Nov-2021 29-Apr-2022 30-Jun-2023 Contract for survey has not yet been finalized. Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P167581 IBRD-89450 Effective USD 328.00 328.00 0.00 121.32 206.68 37% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P167581 IBRD-89450 Effective 15-May-2019 27-Jun-2019 09-Sep-2019 30-Sep-2024 30-Sep-2024 Cumulative Disbursements 6/26/2022 Page 7 of 8 The World Bank Implementation Status & Results Report Andhra Pradesh Health Systems Strengthening Project (P167581) Restructuring History Level 2 Approved on 20-Apr-2020 ,Level 2 Approved on 09-Jun-2021 Related Project(s) There are no related projects. 6/26/2022 Page 8 of 8