The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Tamil Nadu Health System Reform Program (P166373) SOUTH ASIA | India | Health, Nutrition & Population Global Practice | Requesting Unit: SACIN | Responsible Unit: HSAHN IBRD/IDA | Program-for-Results Financing | FY 2019 | Team Leader(s): Rifat Afifa Hasan Seq No: 4 | ARCHIVED on 02-Sep-2020 | ISR43013 | Created by: Rifat Afifa Hasan on 28-Jul-2020 | Modified by: Rifat Afifa Hasan on 26-Aug-2020 Program Development Objectives Program Development Objective (from Program Appraisal Document) The Program Development Objective (PDO) is to improve quality of care, strengthen management of non-communicable diseases and injuries, and reduce inequities in reproductive and child health services in Tamil Nadu. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Implementation Status and Key Decisions The Government of Tamil Nadu is congratulated for achieving all timebound Disbursement-Linked Results as well as exceeding some targets for Year 1 of the Tamil Nadu Health Systems Reform Program (TNHSRP) resulting in a disbursement of US$ 49.9 million on April 27, 2020 for a total disbursement of US$ 52.7 million thus far. These are summarized below. 1. Results Area #1 - Improved Quality of Care: The Tamil Nadu Quality of Care Strategy and health facility quality scorecards have been approval by the SEC in March 2020. In addition, gap assessments were completed which will set the stage for facilities to undergo the quality accreditation process in the upcoming years. 2. Results Area #2 - Strengthened Management of NCDs and Injuries: Implementation of the STEPS survey was halted with the COVID- 19 lockdowns, but a factsheet has been produced based on the bulk of the sample. The Tamil Nadu NCD Strategy was approved by the SEC in March 2020. The trauma registry has made great progress and was piloted in 2 hospitals. IFT protocols have been developed, and the data is currently being analyzed. 3. Cross-Cutting Initiatives to achieve results across the results areas: The District & State Health Assemblies Concept Note, Tamil Nadu Health Policy, Operational Research Program Guidelines, and updated Policy for Continuous Professional Development (TAN- QuEST) were approved by the SEC in March 2020. Finally, the HMIS Concept Note was also finalized on time. Despite Tamil Nadu having the second highest number of COVID-19 infections in India, overall implementation is encouraging with many parts of the TNHSRP managing to have made progress. In particular, the activities related to the provision of quality trauma care have continued to not only make progress but also adapt to the COVID-19 situation to meet more of the needs of the state. In addition, the reproductive and child health cell has also been making progress and using data for programmatic decision-making, even during the COVID-19 crisis. The NCD results area has also been making steady progress and adapting service delivery over the last few months. The GoTN has been taking important steps to ensure that the delivery of key NCD services continues during the COVID-19 pandemic (e.g. diabetes screening at PHCs by glucometer) and to avoid disruptions in the provision of NCD drugs (e.g. providing 2-month supply of hypertension and diabetes drugs & engaging with NGOs for doorstep delivery of drugs supplied by PHCs). Despite some setbacks in pace of implementation over the last couple of months, the TNHSRP has continued moving forward and is well-positioned to regain momentum with some effort. The State Empowered Committee (SEC) will soon be reviewing the second year activities proposed under the TNHSRP which will be critical for not only achievement of the second-year DLRs but also for stabilizing the health sector for continued essential service delivery amidst COVID-19. More attention to implementation of the Program Action Plan will also be required during FY2020-21. Data on Financial Performance Disbursements (by loan) 9/2/2020 Page 1 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P166373 IBRD-89340 Effective USD 287.00 287.00 0.00 52.74 234.26 18% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P166373 IBRD-89340 Effective 19-Mar-2019 04-Jun-2019 29-Jul-2019 31-May-2024 31-May-2024 DLI Disbursement Achievement Disbursed amount in Disbursement % for DLI ID DLI Type Description Coc DLI Amount Status Coc DLI Loan: IBRD89340-001 DLI1 Impl of imr in Pri Sec Partially 1 Regular USD 43,732,000.00 11,000,000.00 25 % Tert fac Achieved DLI2 Inc no of Pub Fac Partially 2 Regular USD 38,200,000.00 11,253,000.00 29 % with Certifi Achieved DLI3 Inc Shr of adult Hyp Partially 3 Regular USD 48,885,500.00 8,985,500.00 18 % Diab under Cnt Achieved DLI4 Impr Prov of Trauma Partially 4 Regular USD 17,715,000.00 2,035,000.00 11 % Care Serv Achieved DLI5 Inc Util Reprod Child 5 Regular USD 56,500,000.00 Not Achieved 0.00 Serv Prio Dis DLI6 Strgn Cont, Qual, Partially 6 Regular USD 36,500,000.00 6,000,000.00 16 % Access Dec Mak Achieved DLI7 Strgn Coord, Integ, Partially 7 Regular USD 30,750,000.00 8,750,000.00 28 % Perf bas Mgt Le Achieved DLI8 Inc transp, account, Partially 8 Regular USD 14,000,000.00 4,000,000.00 29 % Citi Eng Achieved Program Action Plan Increase bidder participation: (i) establish procurement complaint redressal system; and (ii) organize annual supplier Action Description forum/conferences Source DLI# Responsibility Timing Timing Value Status TNMSC, ELCOT, Fiduciary Systems Recurrent Continuous In Progress PWD Completion Measurement (i) procurement complaint redressal system established; (ii) annual supplier forum/conferences organized (i) completed by TNMSC and ELCOT; to be completed by TNPWD by September 30, 2020 (ii) completed by TNMSC; to be completed by ELCOT by August 31, 2020, and TNPWD by September 30, Comments 2020 9/2/2020 Page 2 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Strengthen FM capacity in NHM: (i) assessment to identify gaps in staffing and policies; (ii) training programs for Action Description accounting staff; (iii) greater use of expenditure module of PFMS; (iv) strengthen concurrent audit system. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NHM Society Recurrent Continuous In Progress Completion Measurement (i) gap assessment report; (ii) training programs organized; (iii) PFMS usage report; and (iv) concurrent audit report (i) Virtual training program on accounting and PFMS will be organized in Q2 and Q3 of the govt FY. Comments (ii) NHM State Society will initiate the process to develop audit manuals / detailed audit checklists and audit ToRs. Enhance transparency: (i) publicly disclose contract awards of value greater than INR 20 Million (approx. US$ Action Description 285,720); and (ii) collate information on fraud and corruption-related complaints and provide information to WB on a quarterly basis Source DLI# Responsibility Timing Timing Value Status TNMSC, ELCOT, Fiduciary Systems PWD; Secretariat, Recurrent Continuous In Progress DOHFW (i) report on disclosure by the procurement agencies; and (ii) quarterly report on fraud and corruption-related Completion Measurement complaints (i) completed by ELCOT; to be completed by TNMSC by September 1, 2020, and TNPWD by September 30, Comments 2020. (ii) information till December 31, 2019, to be shared by August 31, 2020. Action Description BMWM: performance audits for the CTFs have to be undertaken Source DLI# Responsibility Timing Timing Value Status Environmental and Social TNHSRP PMU Recurrent Yearly Delayed Systems Completion Measurement Annual performance audit conducted and reports publicly disclosed by the competent authority TNHSRP will organize a virtual meeting with the Bank team and State Pollution Control Board for developing the TOR Comments for the performance audit of the CTFs in the state. It is agreed that the first performance audit to be completed by December 2020 Action Description Introduce continuous refresher trainings on biomedical and other waste management Source DLI# Responsibility Timing Timing Value Status Environmental and Social TNSHRP PMU and Recurrent Continuous In Progress Systems DME Completion Measurement New refresher training course rolled out for healthcare staff across all healthcare facilities 9/2/2020 Page 3 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) One training on BMWM was imparted in December 2019 and since then there is a gap due to ongoing COVID-19 Comments pandemic. Under this situation, it is critical to also monitor biomedical waste generated due to COVID-19. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Moderate Moderate Macroeconomic Low Low Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Low Low Moderate Sustainability Fiduciary Moderate Moderate Moderate Environment and Social Moderate Moderate Moderate Stakeholders Low Low Low Other Low -- High Overall Moderate Moderate Moderate RiskComments Comments There is a high risk of COVID-19 affecting TNHSRP implementation - both directly in terms of health sector capacity to manage and indirectly in terms of macroeconomic risk due to additional fiscal constraints. TNHSRP in particular for a variety of reasons, including but not limited to: (a) the state of Tamil Nadu has the second highest number of COVID-19 cases in India, (b) the health sector is overwhelmed with managing the COVID-19 situation which has persisted for the last 4 months with an unpredictable trajectory, and (c) the fiscal constraints at state level that go beyond the health sector. Results PDO Indicators by Objectives / Outcomes Improved Quality of Care and Reduced Equity Gaps in Reproductive and Child Health IN00878180 ►Increased number of public facilities with quality certification (primary, secondary, and tertiary) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) Tertiary facilities (i) Tertiary (i) Tertiary (i) Tertiary facilities with entry level NABH facilities with entry level facilities with entry level with entry level NABH accreditation: 0 NABH accreditation: 0 NABH accreditation: 0 certification: 7 Value (ii) Secondary (ii) Secondary (ii) Secondary (ii) Secondary facilities facilities with NQAS facilities with NQAS facilities with NQAS with NQAS certification: 3 certification: 7 out of certification: 27 out of certification: 70 of 9/2/2020 Page 4 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) (iii) Primary facilities which 2 are in priority which 8 are in priority which 14 are in the with NQAS certification: 4 districts districts priority districts (iii) Primary (iii) Primary (iii) Primary facilities facilities with NQAS facilities with NQAS with NQAS certification: 21 out of certification: 36 out of certification: 300 of which 5 are in priority which 11 are in priority which 60 are in the districts districts priority districts Date 01-Nov-2018 14-Feb-2020 31-Mar-2020 01-Jul-2024 This indicator measures the number of facilities receiving quality certification during the Program period. Specifically, it monitors the: • number of medical colleges (tertiary facilities) with entry level NABH certification; • number of District Head Quarter, Taluk and non-Taluk Hospitals (secondary facilities) with full Comments NQAS certification; • number of CHCs and PHCs (primary facilities) with full NQAS certification. The indicator also monitors the number of facilities of each level receiving quality certification in priority districts. The priority districts are: Ariyalur, Dharmapuri, Ramanathapuram, The Nilgris, Theni, Thoothukkudi, Tirunelveli, Tiruvannamalai, Virudhunagar. IN00878230 Tertiary facilities with entry level NABH certification (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 7.00 Date 01-Nov-2018 14-Feb-2020 31-Mar-2020 01-Jul-2024 IN00878234 Secondary facilities with NQAS certification (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 7 out of which 2 are in 27 out of which 8 are in 70 of which 14 are in Value 3.00 priority districts priority districts the priority districts Date 01-Nov-2018 14-Feb-2020 31-Mar-2020 01-Jul-2024 IN00878239 Primary facilities with NQAS certification (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 21 out of which 5 are in 36 out of which 11 are in 300 of which 60 are in Value 4.00 priority districts priority districts the priority districts Date 01-Nov-2018 14-Feb-2020 31-Mar-2020 01-Jul-2024 Improved Quality of Care IN00878226 ►Improved scores in quality dashboard for primary, secondary, and tertiary level facilities (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target NA – to be measured after to be measured after to be measured after Value quality dashboard is quality dashboard is quality dashboard is To be established established established established. Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 A quality dashboard will be developed for primary, secondary, and tertiary level facilities in Year 1. This Comments indicator will track the improvement on the quality dashboard score of these facilities on an annual basis. The baseline and target scores will be established once the dashboard is developed. Strengthened Management of Non-Communicable Diseases and Injuries IN00878229 9/2/2020 Page 5 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) ►Increased screening in public sector facilities for cervical and breast cancers (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Cervical cancer: 10.27% Cervical cancer: Breast cancer: 13.13% 13.47% Cervical cancer: 15.8% Breast cancer: 17.25% Cervical cancer: 30% Value Date reported from April- Breast cancer: 19.5% Breast cancer: 30% December 2019; final Date reported for Apr- figures would be reported 19 to Mar-20 post March 2020 Date 01-Nov-2018 14-Feb-2020 31-Mar-2020 01-Jul-2024 % of women age 30+ screened for cervical and breast cancer in public sector facilities Numerator: number Comments of women age 30+ screened for cervical/breast cancers in public sector facilities Denominator: number of women age 30+ IN00878233 Cervical cancer (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 15.80 10.27 13.47 30.00 Date 01-Nov-2018 14-Feb-2020 31-Mar-2020 01-Jul-2024 IN00878237 Breast cancer (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 19.50 13.13 17.25 30.00 Date 01-Nov-2018 14-Feb-2020 31-Mar-2020 01-Jul-2024 Improved Quality of Care and Strengthened Management of Non-Communicable Diseases and Injuries IN00878227 ►Increased share of adults with hypertension or diabetes whose blood pressure or blood sugar are under control (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Hypertension under control: 3 percentage point increase from NA - to be established to be measured after to be measured after baseline Value after STEPS is STEPS is implemented STEPS is implemented Diabetes under implemented in 2019 control: 6 percentage point increase from baseline Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 (i) % of individuals age 30+ with hypertension whose blood pressure is under control;(ii) % of individuals age Comments 30+ with diabetes whose blood glucose level is under control. Numerators and denominators specified in the DLI verification protocol. IN00878231 Hypertension under control (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target NA - to best established to be measured after to be measured after 3 percentage point Value after STEPS is STEPS is implemented STEPS is implemented increase from baseline implemented in 2019 9/2/2020 Page 6 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 IN00878235 Diabetes under control (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target NA - to best established to be measured after to be measured after 6 percentage point Value after STEPS is STEPS is implemented STEPS is implemented increase from baseline implemented in 2019 Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 IN00878238 ►Improved provision of quality trauma care services (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) # of trauma centers (i) # of trauma centers (i) # of trauma centers (i) # of trauma centers using trauma registry: using trauma registry: 0 using trauma registry: 2 using trauma registry: 2 54 (ii) % of surgical ED (ii) % of surgical ED (ii) % of surgical ED (ii) % of surgical ED Value admissions: 6.7% admissions: 6.7% admissions: 6.7% admissions: 15% (iii) % of IFT calls as a % (iii) % of IFT calls as a % (iii) % of IFT calls as a (iii) % of IFT calls as a of total 108 system calls: of total 108 system calls: % of total 108 system % of total 108 system 41.1% 41.1% calls: 41.1% calls: 30% Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 (i) Number of trauma centers using trauma registry (ii) % of surgical ER admissions in Group A and B facilities* who received surgery within 6 hours in the same institution Numerator and denominator specified Comments in the DLI verification protocol. *Group A surgeries include general, orthopedic, plastic, vascular and neuro surgeries; Group B surgeries are limited to general and orthopedic. (iii) % of inter-facility transfer calls as a % of total 108 system calls Numerator and denominator specified in the DLI verification protocol. IN00878241 # of trauma centers using trauma registry (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 54.00 Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 IN00878242 % of surgical ED admissions (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 6.7% 6.7% 6.7% 15% Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 IN00878243 % of IFT calls as % of total 108 system calls (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 41.1% 41.1% 41.1% 30% Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 Reduced Equity Gaps in Reproductive and Child Health IN00878228 9/2/2020 Page 7 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) ►Increased utilization of reproductive and child health services in priority districts (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) Full ANC: 28.8% (i) Full ANC: 28.8% (ii) Fully immunized: (ii) Fully immunized: (i) Full ANC: 28.8% 57.9% 57.9% (i) Full ANC: 41.3% (ii) Fully immunized: (iii) mCPR: 38.5% (iii) mCPR: 38.5% (ii) Fully immunized: Value 57.9% 70.4% (iii) mCPR: 38.5% To be reported after the To be reported after the (iii) mCPR: 43.5% new round of NFHS data new round of NFHS is available data is available Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 This indicator monitors the utilization of select RCH services in the 9 priority districts: Ariyalur, Dharmapuri, Ramanathapuram, The Nilgris, Theni, Thoothukkudi, Tirunelveli, Tiruvannamalai, Virudhunagar. The priority districts were identified based on their performance on RCH indicators and proportion of ST population. Three RCH indicators will be monitored: full immunization, full antenatal care, and use of modern methods of contraception. Numerators and denominators specified in the DLI verification protocol. Full antenatal care Comments (ANC): Pregnant women receiving at least four ANC visits, at least one TT injection, and taken IFA tablets or syrup for 100 or more days. Full immunization: Children 12-23 months receiving vaccinations against tuberculosis, diphtheria, pertussis, tetanus, polio, and measles. Modern contraceptive prevalence rate (mCPR). Modern methods include male and female sterilization, injectables, intrauterine devices (IUDs/PPIUDs), contraceptive pills, implants, female and male condoms, diaphragm, foam/jelly, the standard days method, the lactational amenorrhoea method, and emergency contraception. IN00878232 Full ANC (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 28.80 28.80 28.80 41.30 Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 IN00878236 Fully immunized (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 57.90 57.90 57.90 70.40 Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 IN00878240 mCPR (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 38.50 38.50 38.50 43.50 Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 Intermediate Results Indicators by Results Areas Result #1: Improved Quality of Care IN00878244 ►Implementation of quality improvement interventions in primary, secondary, and tertiary care facilities (Text, Custom) 9/2/2020 Page 8 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Baseline Actual (Previous) Actual (Current) End Target (i) Number of facilities implementing (i) Number of primary, (i) Number of primary, (i) Number of primary, at least 1 endorsed secondary, and tertiary secondary, and tertiary secondary, and tertiary quality improvement level facilities level facilities level facilities initiative from the list of implementing at least 1 implementing at least 1 implementing at least 1 evidence-based endorsed quality endorsed quality endorsed quality interventions specified improvement initiative improvement initiative improvement initiative in the QoC Strategy: from the list of evidence- from the list of evidence- from the list of Primary: 570 and based interventions based interventions evidence-based Value Secondary and specified in the QoC specified in the QoC interventions specified tertiary:248 ………….. Strategy: 0 ………….. (ii) Strategy: 0 ………….. (ii) in the QoC Strategy: 0 (ii) Number of Number of primary, Number of primary, ………….. (ii) Number facilities reporting on secondary, and tertiary secondary, and tertiary of primary, secondary, quality dashboard facilities reporting on facilities reporting on and tertiary facilities quarterly: Primary: 570 quality dashboard quality dashboard reporting on quality and Secondary and quarterly: 0 quarterly: 0 dashboard quarterly: 0 tertiary: 248 Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 This indicator tracks the implementation of at least one endorsed quality improvement initiative from the list of evidence-based interventions specified in the QoC Strategy and the number of facilities reporting on the quality dashboard quarterly. The indicator monitors each intervention at the primary and secondary/tertiary facilities. The quality dashboard will include indicators to measure quality of care along the three dimensions Comments of quality: structural inputs, clinical processes, and patient outcomes. The GoTN and the World Bank will develop this dashboard jointly. The indicators will vary by level of facility. Following development of the dashboard, primary, secondary, and tertiary facilities will be monitored for quarterly reporting on the quality dashboard. Numerators and denominators specified in the DLI verification protocol. IN00878247 ►Piloting of patient experience questionnaire for secondary & tertiary care facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 A detailed patient experience questionnaire – expanding the concept of the Mera Aspatal survey to measure patient satisfaction – will be developed for patients visiting secondary & tertiary facilities. This indicator will Comments track the % of secondary & tertiary facilities piloting this patient experience questionnaire. Numerator: number of secondary & tertiary facilities piloting the patient experience questionnaire. Denominator: total number of secondary & tertiary facilities Result #2: Strengthened Management of Non-Communicable Diseases and Injuries IN00878250 ►Increased share of primary & secondary facilities with at least one staff trained on mental health (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40.00 Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 This indicator measures the % of primary & secondary facilities with at least one staff trained on mental health. Numerator: number of primary & secondary facilities with at least one staff receiving face-to-face Comments training on mental health. Denominator: total number of primary & secondary facilities. The indicator would be reported once the training on mental health starts in this FY (Apr 2020-Mar 2021) 9/2/2020 Page 9 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) IN00878252 ►Establishment of suicide hotline (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2021 TN has a functional toll-free number (104) for counselling on health issues and grievances related to health Comments services. Under the Program, a hotline linked to the 104 health helpline will be developed for counselling related to suicide contemplation and attempts. IN00878253 ►Better equipped ambulance system to improve pre-hospital care -number of ATLS ambulances providing Level 1 care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 64.00 62.00 122.00 164.00 Date 01-Nov-2018 14-Feb-2020 31-Mar-2020 01-Jul-2024 Comments Number of ATLS ambulances providing Level 1 care during the year. IN00878256 ►Improved capacity of trauma care providers - number of emergency department providers that received Level 3 (BTLS) and Level 4 training (ATLS) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Level 3: Nurses - 165; Level 3: Nurses - 1005; Level 3: Nurses - 1548; Level 3: Nurses - Doctors - 100. Doctors - 632. Doctors - 883. 9000; Doctors - 6000. Value Level 4: Nurses - 0; Level 4: Nurses - 78; Level 4: Nurses - 156; Level 4: Nurses - 900; Doctors - 0. Doctors - 41. Doctors - 119. Doctors - 600. Date 01-Nov-2018 14-Feb-2020 31-Mar-2020 01-Jul-2024 This indicator measures the number of emergency department providers that received Level 3 (BTLS) and Comments Level 4 training (ATLS) during the year. Result #3: Reduced Equity Gaps in Reproductive and Child Health IN00878246 ►Implementation of updated social and behavior change communication (SBCC) strategy (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 This indicator tracks progress on the implementation of annual workplans developed as part of a Comments comprehensive SBCC Strategy. The SBCC strategy will include messages on NCDs and their risk factors (including mental health), road safety, and RCH in priority districts IN00878249 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 846,331.00 922,179.00 3,600,000.00 Date 29-Mar-2019 31-Dec-2019 31-Mar-2020 01-Jul-2024 This indicator tracks number of children who have received immunization services in the state. Comments 9/2/2020 Page 10 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) IN00878254 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 846,331.00 922,179.00 3,600,000.00 Date 29-Mar-2019 31-Dec-2019 31-Mar-2020 01-Jul-2024 Cross-Cutting Results IN00878245 ►Strengthened content, quality, accessibility, and use of data for decision making (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Conceptual Model and Conceptual Model and Conceptual Model and Operational Plan for a Operational Plan for a Operational Plan for a strengthened and Integrated system strengthened and strengthened and integrated Health implemented in all the Value integrated Health integrated Health Management health facilities in 9 Management Information Management Information Information System districts: Yes System (HMIS) : draft System (HMIS) : No (HMIS): developed and being developed approved Date 01-Nov-2018 14-Feb-2020 31-Mar-2020 01-Jul-2024 A Conceptual Model and Operational Plan for a strengthened Health Management Information System (HMIS) covering all data sources, data users and data channels including integration with electronic medical records and patient tracking for NCDs will be developed in Year 1. In Year 2, a detailed model and detailed design specifications will be completed based on the Conceptual Model and Operational Plan. In Year 3, a Comments contract will be awarded for development of integrated HMIS, and key modules (electronic health record and reporting) will be piloted in at least 1 primary, 1 secondary, and 1 tertiary facility in a district. In Year 4, the indicator will monitor the implementation of an integrated system in all the health facilities of at least one district (as determined by a GoTN order). In Year 5, the integrated system will be implemented in all the health facilities of up to an additional 8 districts of Tamil Nadu. IN00878248 ►Strengthened coordination, integration, performance-based management, learning, and other cross-cutting functions for better results (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) 1 annual call for research proposals issued and selected Policies/Strategies for proposal awarded. TN Health Policy Value Policies/Strategies: No Year-1: drafts prepared (ii) Development & Developed & adopted and are being finalized adoption of performance-based incentive strategy for PHCs: Yes. Date 01-Nov-2018 14-Feb-2020 31-Mar-2020 01-Jul-2024 This indicator tracks development and adoption of the following policies, strategies, and activities. Year 1: • TN Health Policy/ Strategy for Vision 2030; • Development and adoption of an Environment Strategy for the Health Sector in Tamil Nadu. Year 2: • Launch of the operational research program with 1 annual call for research proposals issued and selected proposal awarded. • Deploying e-procurement system in TNMSC Comments and 20% of value of total contracts of TNMSC under the Program done through e-procurement. Year 5: • Development and adoption of performance-based incentive strategy for PHCs. Year 3-5: One annual call for research proposals issues and selected proposals awarded. IN00878251 ►Increased transparency and accountability through citizen engagement (voice, agency, and social accountability) (Text, Custom) 9/2/2020 Page 11 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Baseline Actual (Previous) Actual (Current) End Target Districts conducting Guideline for state & Districts conducting Health Districts conducting Health Assembly: District Health Value Assembly: 0%. Health Assembly: 0%. 60%. Assembly developed & State Health Assembly: 0 State Health Assembly: 0 State Health adopted Assembly: 1 Date 01-Nov-2018 14-Feb-2020 31-Mar-2020 01-Jul-2024 Year 2 onward, the indicator will monitor the share of districts conducting health assemblies/forums and Comments whether an annual State Health Assembly was convened. District health assemblies are expected to occur before the State Health Assembly. Numerator and denominator specified in the DLI verification protocol. IN00878255 Districts conducting Health Assembly (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0% 0% 0% 60% Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 IN00878257 State Health Assembly (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 Date 01-Nov-2018 14-Feb-2020 24-Jul-2020 01-Jul-2024 Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 Implementation of quality improvement interventions in primary, secondary, and tertiary care facilities (Output, 43,732,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 (i) At least 1 health facility implementing at least 1 endorsed quality improvement initiative from the list of evidence-based interventions specified in the QoC Strategy: US$20,000 for each Ad hoc implementation of Ad hoc implementation of Ad hoc implementation of primary care facility Value quality improvement quality improvement quality improvement up to 143 facilities initiatives by hospitals initiatives by hospitals initiatives by hospitals and US$30,000 for each secondary and tertiary care facility up to 62 facilities...….(ii) At least 1 health facility reporting on quality dashboard during each quarter of the reporting year: US$14,800 for each 9/2/2020 Page 12 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) additional primary care facility up to 190 facilities and US$22,000 for each additional secondary and tertiary care facility up to 82 facilities from the previous year Date -- 14-Jun-2019 14-Jun-2019 -- Comments ►DLI 2 Increased number of public facilities with quality certification (primary, secondary and tertiary) (Outcome, 38,200,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 (i) US$850,000 for every tertiary care facility certified (up to 2 such facilities)…………...( ii) US$160,0 00 for every (i) Tertiary: 0 (i) Tertiary: 0 additional secondary (ii) Secondary: 7 (i) Tertiary: 0 (ii) Secondary: 7 care facility certified (iii) Primary: 21 (ii) Secondary: 3 (iii) Primary: 21 (up to 21 facilities), Tertiary = medical (iii) Primary: 4 Tertiary = medical with an additional colleges Tertiary = medical colleges colleges US$75,000 for each Value Secondary = district, Secondary = district, taluk, Secondary = district, taluk, of the first 2 that are taluk, and non-taluk and non-taluk hospitals and non-taluk hospitals in the priority hospitals Primary = PHCs and CHCs Primary = PHCs and districts...……...(iii) Primary = PHCs and CHCs US$37,00 CHCs 0 for every additional primary care facility certified (up to 79 facilities), with an additional US$15,000 for each of the first 10 that are in the priority districts Date -- 14-Feb-2020 14-Feb-2020 -- Comments ►DLI 3 Increased share of adults with hypertension or diabetes whose blood pressure or blood sugar are under control (Outcome, 48,885,500.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Value Baseline to be established Baseline to be Baseline to be established (i) The percentage after STEPS is established after STEPS after STEPS is point increase in the implemented in 2019 is implemented in 2019 implemented in 2019 share of hypertensive adults whose blood pressure is under control over the 9/2/2020 Page 13 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) previous survey (with statistical significance) up to 1.5 percentage points increase - US$7.3 million for every percentage point increase ……………………… (ii) The percentage point increase in the share of diabetic adults whose blood glucose is under control over the previous survey (with statistical significance) up to 3 percentage points increase - US$3 million for every percentage point increase Date -- 14-Jun-2019 14-Jun-2019 -- Comments ►DLI 4 Improved provision of quality trauma care services (Outcome, 17,715,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Value (i) # of trauma centers (i) # of trauma centers (i) # of trauma centers (i) Increase in the using trauma registry: 0 using trauma registry: 2 using trauma registry: 2 number of trauma ……………….(ii) % of ……………….(ii) % of ……………….(ii) % of centers where the surgical emergency surgical emergency surgical emergency trauma registry is in department admissions in department admissions department admissions in use - US$35,000 for Group A and B facilities in Group A and B Group A and B facilities each additional who received surgery within facilities who received who received surgery trauma center from 6 hours of admission in the surgery within 6 hours of within 6 hours of the previous year same institution: 6.7% admission in the same admission in the same operating a trauma ……………….(iii) % of IFT institution: 6.7% institution: 6.7% registry up to 14 calls as a % of total 108 ……………….(iii) % of ……………….(iii) % of IFT trauma centers system calls: 41.1% IFT calls as a % of total calls as a % of total 108 ………….. (ii) 108 system calls: 41.1% system calls: 41.1% Percentage point increase in surgical emergency department admissions in Group A and B facilities who received surgery within 6 hours of admission - US$600,000 for every percentage point increase up to 3 percentage points ……………. (iii) Percentage point decrease in IFT calls as a percent of total 9/2/2020 Page 14 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) 108 system calls - US$800,000 for every percentage point decrease up to 2 percentage points Date -- 14-Feb-2020 14-Feb-2020 -- Comments ►DLI 5 Increased utilization of reproductive and child health services in priority districts (Outcome, 56,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 (i) Percentage point increase in women receiving full ANC compared to the previous survey (with statistical significance) - US$1,600,000 for every percentage point increase from baseline up to 5 (i) Women receiving full percentage points ANC: 28.8% ……………… ……………………… (ii) Children 12–23 months .. (ii) Percentage fully immunized: 57.9% point increase in full …………….. (iii) Modern immunization of contraception prev. rate: (i) Women receiving full children 12–23 38.5% (i) Women receiving full ANC: 28.8% months compared to ANC: 28.8% ……………… ……………… (ii) the previous survey Definitions: (a) Full ANC (ii) Children 12–23 months Children 12–23 months (with statistical means at least four ANC fully immunized: 57.9% Value fully immunized: 57.9% significance) - visits, at least one tetanus …………….. (iii) Modern …………….. (iii) Modern US$1,600,000 for toxoid injection, and having contraception prev. rate: contraception prev. rate: every percentage taken IFA tablets or syrup 38.5% 38.5% point increase from for 100 or more days. (b) baseline up to 5 Full immunization means percentage points vaccinations against ……………………… tuberculosis, diphtheria, ….. (iii) Percentage pertussis, tetanus, polio, point increase in and measles modern contraceptive prevalence rate compared to the previous survey (with statistical significance) - US$3,300,000 for every percentage point increase from baseline up to 2 percentage points Date -- 14-Jun-2019 14-Jun-2019 -- Comments 9/2/2020 Page 15 of 16 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) ►DLI 6 Strengthened content, quality, accessibility, and use of data for decision-making (Output, 36,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Integrated HMIS implemented in all the health facilities in at least 1 HMIS in place but HMIS in place but HMIS in place but additional district of Value fragmented across data fragmented across data fragmented across data Tamil Nadu - streams/ databases streams/ databases streams/ databases US$1,000,000 per district up to a maximum of 8 districts Date -- 14-Jun-2019 14-Jun-2019 -- Comments ►DLI 7 Strengthened coordination, integration, performance-based management, learning, and other cross-cutting functions for better results (Process, 30,750,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Annual call for research proposals Value NA NA NA issued and selected proposal awarded - US$ 3,000,000 Date -- 14-Jun-2019 14-Jun-2019 -- Comments ►DLI 8 Increased transparency and accountability through citizen engagement (voice, agency, and social accountability) (Output, 14,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 (i) At least 40% of all districts conducted health assembly during the year - US$3,000,000 Value NO No No ………….. (ii) Tamil Nadu conducted state health assembly during the year - US$250,000 Date -- 14-Jun-2019 14-Jun-2019 -- Comments 9/2/2020 Page 16 of 16