The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Sint Maarten Hospital Resiliency & Preparedness Project (P167532) LATIN AMERICA AND CARIBBEAN | St Maarten | Health, Nutrition & Population Global Practice | Recipient Executed Activities | Investment Project Financing | FY 2019 | Seq No: 4 | ARCHIVED on 25-Jun-2020 | ISR41383 | Implementing Agencies: Ministry of Public Health, Social Development and Labour (VSA), Sint Maarten Medical Center (SMMC) Key Dates Key Project Dates Bank Approval Date: 16-Aug-2018 Effectiveness Date: 06-Sep-2018 Planned Mid Term Review Date: -- Actual Mid-Term Review Date: Original Closing Date: 31-Jul-2023 Revised Closing Date: 31-Jul-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) Improve the preparedness and capacity of hospital services in Sint Maarten Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Building and launching of the new hospital:(Cost $17000000.00 M) Transition and Contingency Plan for Sint Maarten Medical Center:(Cost $7700000.00 M) Project Management:(Cost $300000.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions The Sint Maarten Hospital Resiliency and Preparedness Project was approved on August 16, 2018 and the project was formally launched in October 2018. SMMC has a dedicated staff and commitment to this project and support from the Ministry of Public Health, Social Development and Labor (VSA) has been critical. This project will contribute to improving resilience as it not only focuses on a new building but will also improve the quality and expand the scope of hospital services for the population of Sint Maarten. Initiation of early works for the new hospital construction began in January 2020, was temporarily paused due to COVID-19 restrictions and resumed on June 15, 2020. To date, achievements supported by the project include completion of the existing hospital’s roof that was reinforced to sustain category 4 winds (up from category 2), installation of a new fire detection system, access control system installation, completion of ICT upgrades, installation of back-up generator, updating of the emergency disaster preparedness plan, and ongoing efforts to improve patient safety and quality of care. In response to the COVID-19 pandemic demands on the preparedness and capacity of hospital services in Sint Maarten, the Steering Committee of the Sint Maarten Hurricane Irma Reconstruction, Recovery and Resilience Trust Fund (TF) approved additional financing to the project in the amount of US$3.6 million on March 20, 2020. 6/25/2020 Page 1 of 6 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Moderate Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Moderate Moderate Sustainability Fiduciary Substantial Moderate Moderate Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Moderate Moderate Results PDO Indicators by Objectives / Outcomes Improve capacity of hospital services IN00831193 ►Overseas medical referrals reduced (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 79.00 79.00 45.00 Date 31-May-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 This indicator measures the percent decrease in the number of overseas medical referrals. A referral is defined based on the date SMMC determines they cannot provide treatment at SMMC. Actual (Current) is Comments: based on Q1 – Q3 2019 vs Q1 – Q3 Baseline (2017) data. Improve preparedness of hospital services IN00831194 ►Emergency Disaster Preparedness Plan and Evacuation Plan implemented according to procedures (Percentage, Custom) 6/25/2020 Page 2 of 6 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 60.00 60.00 90.00 Date 31-May-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 This indicator will measure how well the updated plans are implemented through the application of a scorecard which will grade the performance of each area of the plan. A consultancy to support this process is underway and data for this indicator will be reported on in 2020. The Hurricane Plan has been Comments: completed while the Fire Safety and Evacuation Plan is being updated. A Disaster Preparedness Scorecard has been developed which grades each of these based on a specific set of criteria for each plan. IN00831195 ►Technical audits to evaluate quality and preparedness of service delivery rated satisfactory (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 90.00 Date 31-May-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 Internal technical audits will determine whether clinical guidelines and quality control mechanisms have been implemented in the selected cases and the percentage of these cases that are rated Satisfactory. Comments: Selected cases will be defined in the technical audit protocol to be developed during the first year of project implementation. Intermediate Results Indicators by Components Building and launching of the new hospital IN00831201 ►Progress in construction of new hospital as per category 5 plus specifications (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3.40 3.40 100.00 Date 31-May-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 This indicator will measure the percentage progress in construction of the new hospital as per Category 5 plus specifications. The design phase will also be included in the calculation as part of the overall Comments: progress in construction. IN00831203 ►Emergency Disaster Preparedness Plan and Evacuation Plan updated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Jun-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 The EDPP has been updated, the Evacuation Plan is still under review. Comments: IN00831205 6/25/2020 Page 3 of 6 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) ►Health personnel trained (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 300.00 Date 01-Jun-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 This indicator will measure the number of SMMC health personnel trained throughout project Comments: implementation. IN00831207 ►Storage capacity to improve preparedness (Square Meter(m2), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 82.00 82.00 82.00 208.00 Date 01-Jun-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 Greater storage capacity is needed to ensure the provision of services even when extreme weather does Comments: not allow for the delivery of supplies. IN00831210 ►Impact of extreme weather conditions on hospital services (admissions, referrals, surgeries) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 60.00 60.00 20.00 Date 31-May-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 This indicator will measure the percent change of services provided 60 days before and 60 days after an extreme weather event to gauge the impact of the event on the hospital's capacity to remain operational. The specific services tracked will include the number of admissions, surgeries and referrals. "Extreme Comments: weather conditions" include Category 2 hurricanes and higher. In the possible case of multiple, back to back extreme weather events, the indicator would measure 60 days before the first event and 60 days after the last event. Transition and Contingency Plan for Sint Maarten Medical Center IN00831202 ►Progress in essential upgrades to the existing hospital (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 25.00 25.00 100.00 Date 01-Jun-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 Comments: This indicator will measure the percent progress of essential upgrades completed. IN00831204 ►Contingency Plan in place for continuous services during works and reallocation of services (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes 6/25/2020 Page 4 of 6 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Date 01-Jun-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 Updated contingency plan (fall back scenario in case of disasters) in place for continuous services during Comments: works and reallocation of services. IN00831206 ►Increased patient satisfaction (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 62.40 62.40 85.00 Date 01-Jun-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 SMMC patient satisfaction surveys – already existing mechanism that has been enhanced, including Comments: disaggregation of results by gender. IN00831208 Increased patient satisfaction - females (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 64.00 64.00 85.00 Date 02-Jul-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 IN00831209 ►Updated clinical guidelines for 20 prevalent health problems implemented and evaluated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Jun-2018 15-Nov-2019 15-Nov-2019 31-Jul-2023 This indicator will be measured as part of the technical audit. Data for this indicator is not expected until Comments: 2021. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P167532 TF-A8176 Effective USD 25.00 25.00 0.00 12.59 12.41 50% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P167532 TF-A8176 Effective 10-Aug-2018 22-Aug-2018 06-Sep-2018 31-Jul-2023 31-Jul-2023 6/25/2020 Page 5 of 6 The World Bank Implementation Status & Results Report Sint Maarten Hospital Resiliency & Preparedness Project (P167532) Cumulative Disbursements PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History There has been no restructuring to date. Related Project(s) P174023-Additional Financing for the Sint Maarten Hospital Resiliency & Preparedness Project 6/25/2020 Page 6 of 6