The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Emergency Tuberculosis Project (P160947) EAST ASIA AND PACIFIC | Papua New Guinea | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 7 | ARCHIVED on 29-Jun-2020 | ISR42567 | Implementing Agencies: Department of Treasury, National Department of Health Key Dates Key Project Dates Bank Approval Date: 31-May-2017 Effectiveness Date: 25-Sep-2017 Planned Mid Term Review Date: 30-Oct-2020 Actual Mid-Term Review Date: Original Closing Date: 30-Jun-2022 Revised Closing Date: 30-Jun-2022 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To Improve the quality and expand the coverage and utilization of health services to control the spread of tuberculosis in targeted areas of Papua New Guinea by strengthening programmatic management of tuberculosis. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Early detection of active tuberculosis patients:(Cost $3.55 M) Effective treatment of drug-susceptible and drug-resistant tuberculosis patients:(Cost $7.70 M) Strengthening government systems for managing its health services delivery and tuberculosis response:(Cost $3.75 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 High High Implementation Status and Key Decisions Project implementation continues to progress on several aspects: (1) Two mobile vans which are fully equipped with the GeneXpert machines and digital x-rays have arrived in Port Moresby and have been handed over to the National Capital District (NCD) Provincial Health Authority (PHA) team; (2) 14 GeneXpert machines arrived in Port Moresby in August 2019, and 12 have been installed in the Basic Management Units (BMUs) across NCD; 2 GeneXpert machines are yet to be allocated at their designated laboratories as their laboratory technicians have not yet been trained; (3) The Line Probe Assay (LPA), used to detect resistance to second line drugs, purchased by the Australian Department of Finance and Trade, has been operational since December 2019 with support from two laboratory technicians funded by the Project. In addition, the Project is funding consumables required for the LPA; and (4) Since April 1, 2020, the Project is funding the provision of community-based treatment and diagnostic support in NCD delivered by World Vision International. 6/29/2020 Page 1 of 11 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Despite this progress, it should be noted that the COVID-19 pandemic and State of Emergency in PNG have disrupted some aspects of implementation: (1) The systematic TB screening exercise in the NCD has now been deferred to the third quarter of this calendar year; and (2) The supervision and monitoring of TB control services in the BMUs in NCD and Western Province has been adversely affected as staff and attention have been redeployed to the COVID-19 preparedness and response efforts in these localities. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic Substantial Substantial High Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Low Low Low Institutional Capacity for Implementation and High High High Sustainability Fiduciary High High High Environment and Social Low Moderate Moderate Stakeholders Substantial Substantial Substantial Other -- High -- Overall High High High Results PDO Indicators by Objectives / Outcomes To Improve the quality and expand the coverage and utilization of health services to control the spr IN00865194 ►Number of people receiving tuberculosis treatment in accordance with the national guidelines (NCD) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 6,169.00 6,783.00 6,800.00 7,100.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, a total of 6,800 TB cases (all forms) enrolled in treatment. The trend of pulmonary clinically diagnosed TB is on the decline from 19% in Q1 2019, 14% in Q2 2019 and 10% in Q3 2019. This is attributed to the fact that more and more clinicians are requesting the use of GeneXpert as the first-line Comments: diagnostic test for TB. TB/HIV collaboration has improved in 2019. TB patients tested for or with known HIV status increased from 52% in Q1 2019 to 88% in Q4 2019 (Overall; 64%), Co-trimoxazole preventive therapy increased from 53% in Q1 2019 to 91% in Q4 2019 (Overall; 80%) and Antiretroviral treatment (ART) uptake increased from 69% in Q1 2019 to 91% in Q4 2019 (Overall; 83%). NCD Health Services 6/29/2020 Page 2 of 11 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) secured 14 GeneXpert (4 modules) machines, two mobile clinics equipped with digital X-ray and GeneXpert machine, and three container-based digital X-ray machines through the Emergency TB Project. The two mobile clinics will be used in population-based screening for active TB in NCD in 2020. This diagnostic equipment will improve the quality of TB diagnosis and TB case notification is expected to increase in 2020. IN00865195 ►Number of people receiving tuberculosis treatment in accordance with the national guidelines (Daru/South Fly District, Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,659.00 551.00 593.00 1,900.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, a total of 593 TB cases (466 drug-susceptible TB and 127 drug-resistant of which 3 were pre-XDR and 2 XDR) enrolled in treatment compared to 559 TB cases (446 drug-susceptible TB and 113 drug-resistant TB) in 2018. This showed an increase in case notification. It is not clear how the original baseline for Daru was determined. The total number of TB patients registered in Daru did not exceed 661 in any given year since 2012: 513 (2012), 601 (2013), 661 (2014), 498 (2015): 480 (2016). Comments: The baseline and target for this indicator will need to be revised after the Mid Term Review. The proposed revised baseline of 480 TB cases is derived from 2016 case notification reports after the national emergency was declared in 2014. The proposed revised target for 2022 would be 612 with the assumption that the TB prevalence in Daru is 3% in a population of 18,854 (SSI, 2018) with an annual population growth of 2%. IN00865196 ►The proportion of TB patients who have received drug-sensitivity testing (DST) (NCD) for Longer regime (LR) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 23.00 45.00 80.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, the proportion of TB patients who have received DST was 79% for the cohort of 2017 in Gerehu ho There is an improvement for the cohort of 2018 and onward given that the CPHL is now performing culture-based ph line probe assay (LPA) was established for rapid detection of drug-resistance (1st and 2nd line) in December 2019. T Comments: on treatment options and patient monitoring. IN00865197 ►The proportion of TB patients who have received DST (Daru/South Fly District,Western Province) for Shorter regime (SR) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 41.00 71.00 40.00 80.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 Comments: In (Q1-Q4) 2019, the proportion of TB patients who have received DST was 44 out of 113 (40%) patients for the cohort of 2018 compared to 38 out of 102 (37%) patients for the cohort of 2017. There is an improvement. However, low DST results were attributed to a lack of funding for the transportation of samples from Daru BMU to the Central Public Health Laboratory (CPHL) in 2019. However, the issue of specimen transportation was addressed through funding from the Emergency TB Project. 6/29/2020 Page 3 of 11 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) IN00865198 ►TB treatment success rate for DS TB (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 56.00 78.00 87.00 85.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, treatment success rate (cured & treatment completed) was 87% (86% in Q1 2019, 85% in Q2 2019, 88% in Q3 2019 and 89% in Q4 2019). The treatment success rate reached the WHO recommendation of 85%.NCD results have demonstrated the importance of engaging the community in Comments: TB control through the established network of treatment supporters and supervisors, and regular review meetings. IN00865199 ►TB treatment success rate for DS TB (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 71.00 86.00 85.00 85.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, the TB treatment success rate (TSR) for the cohort of 2018 was 85% (379/446), which is stable. Comments: The treatment success rate has reached the WHO recommendation of an 85% TSR. IN00865200 ►TB treatment success rate for DR TB (NCD) for Shorter regime ( SR) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 44.00 64.00 54.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 Gerehu hospital: - In Q1-4 2019 the TB treatment success rate for DR-TB was 69% (24/35) for the cohort of 2017. PMGH: Comments: - In Q1-4 2019 the TB treatment success rate for DR-TB was 47% (40/86) for the cohort of 2017. IN00865201 ►TB treatment success rate for DR TB for females (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 61.00 58.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 31-Dec-2021 Comments: Data for indicator POI 4b is not routinely collected and has to be collected separately from the TB Register at the facilities registering DR TB patients. Gerehu hospital: - In (Q1-Q4) 2019, the treatment success rate for DR-TB for females was 75% (18/24) for the cohort of 2017. 6/29/2020 Page 4 of 11 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) PMGH: - In (Q1-Q4) 2019, the TB treatment success rate for DR-TB for females was 49% (21/43) for the cohort of 2017. IN00865202 ►TB treatment success rate for DR TB (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 49.00 87.00 88.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, the TB treatment success rate was 88% (91/103) for the cohort of 2017. The treatment success remains high due to good clinical management and the implementation of community-based Comments: activities such as supervised treatment. IN00865203 ►TB treatment success rate for DR TB for females (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 71.40 0.00 93.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, the TB treatment success rate for DR-TB for females was 93% (85/91) for the cohort of Comments: 2017. This is very high and impressive. IN00865204 ►Number of BMUs where all clinical staff have been trained/ retrained on TB and DR TB (NCD & Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 16.00 14.00 20.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, a total of 54 health workers trained/retrained on TB management and 25 health workers trained on TB infection prevention and control from 14 BMUs in NCD. The training enhanced the Comments: knowledge of health workers in TB management (diagnosis and treatment, and recording and reporting) and infection prevention and control measures. Intermediate Results Indicators by Components Early detection of active tuberculosis patients IN00865205 ►Population-based screening in Daru is complete (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 6/29/2020 Page 5 of 11 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) WHO provided technical and coordination support to the population-based screening for active TB case finding in Daru. The screening aimed at detecting active TB and enrolled them in treatment. The screening was launched in February 2018 and completed in March 2019. Digital X-ray was used for screening and those with a CAD4TB score ≥40 were referred for testing using GeneXpert. A total of 69 bacteriologically confirmed TB cases (55 drug-susceptible TB and 14 drug-resistant TB) were detected through the screening activities. This translates to the TB prevalence rate of 853/100,000 population screened, which is extremely high. All these cases were initiated on treatment and notified to the NTP. The results showed: • Screening reached 83% (13,037) of eligible populations; • Sixty-two percent (62%) of the population reached were successfully enrolled in screening; • The coverage and yields were variable across the four wards (Darowaro, Iaru, Karakara, and Tamati) of Comments: Daru Island; • There may be a missed opportunity for detecting possible more cases in Iaru ward where participation rate was low but % yield was the highest; and • The risk factor analysis showed that older people, males, low BMI, people in smaller houses, people with a history of TB and symptoms have higher risks of TB. Recommendations for future population screening for active TB case finding include: a) Use of a unique participant identifier across all screening, testing and treatment encounters; b) Implement an electronic, patient-level data collection system; and c) Focus screening in high-risk groups and populations. A dissemination workshop was conducted with all relevant stakeholders in attendance. IN00865208 ►Number of BMUs with functioning TB Smear microscopy (NCD) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7.00 7.00 7.00 14.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, 7 out of 14 BMUs in NCD have functioning TB smear microscopy and they include; Port Moresby Comments: General Hospital, Gerehu hospital, 6 Mile, Lawes Road, 9 Mile, Badili and Tokarara. IN00865211 ►Number of BMUs with functioning Xpert MTB/Rif (NCD) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 3.00 4.00 14.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, a total of 4/14 BMUs including PMGH, Gerehu hospital, 6 Mile, Lawes Road) had functional GeneXpert (4 modules) machines. There are 14 GeneXpert (4-modules) machines procured through the Emergency TB Project. There are 12 GeneXpert machines in BMUs in NCD. Additional Comments: GeneXpert machines will be installed in NCD in 2020. IN00865214 ►Number of BMUs with functioning TB Smear microscopy (Daru/ South Fly District, Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.00 1.00 2.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 6/29/2020 Page 6 of 11 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Daru BMU is the only diagnostic and therapeutic facility in the South Fly District of Western Province. Mabudawan is a health post used only for the continuation of TB treatment (it does not have a functioning Comments: TB smear microscopy or GeneXpert machine. IN00865216 ►Number of BMUs with functioning Xpert MTB/Rif (Daru/ South Fly District, Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.00 1.00 2.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 Daru General Hospital is the only BMU with a functioning GeneXpert machine (4-modules) in the South Fly District of Western Province. Comments: . Effective treatment of drug-susceptible and drug-resistant tuberculosis patients IN00865206 ►Smear conversion rate among DS TB cases (by 2 months for new cases and 3 months for retreatment cases) (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 73.00 73.00 88.00 85.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, smear conversion rate (SCR) for drug-susceptible (DS) TB cases was 88% (84% in Q1 2019, 90% in Q2 2019, 89% in Q3 2019 and 87% in Q4 2019). These figures do not include 3 months Comments: conversion for retreatment cases, as it is no longer recommended in the national TB guidelines. IN00865209 ►Smear conversion rate among DS TB cases (by 2 months for new cases and 3 months for retreatment cases) (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 78.00 70.00 85.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 Smear conversion rate (SCR) among DS TB cases by 2 months was 78% (28/36) in Q1 2019, 69% (9/13) and 64% in Q3 2019. The average smear conversion rate is 70%. Smear not done contributed to this low conversion rate and that is due to patients unable to produce sputum at the end of 2 months of treatment. Comments: This is common in TB patients detected with scanty Acid Fast Bacilli (AFBs) using GeneXpert. Note: This figure represents 2 months conversion for all DS-TB cases in Daru as 3 months conversion for retreatment cases is no longer used due to changes in the national TB guidelines. IN00865212 ►Culture conversion rate among DR TB cases ( 4 months for shorter course) (NCD) for Shorter Regime (SR) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 87.50 43.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 IN00865217 6/29/2020 Page 7 of 11 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) ►Culture conversion rate among DR TB cases (At 6 months for normal course and 4 months for shorter course) (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.00 0.00 83.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q2) 2019, the culture conversion rate among DR-TB cases at 6 months was 83% (20/24) for the cohort of 2017. There was no culture conversion rate at 4 months since no DR-TB patient was started on a shorter course Comments: regimen. . IN00865218 ►Percentage of Lost to follow up of DS TB patients (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 15.00 2.00 2.70 6.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, Loss To Follow Up (LTFU) rate of DS-TB (all forms of TB) was 2.7% for the entire cohort of 2018. Comments: The LTFU rate has reached the WHO recommended target of less than 5% IN00865219 ►Percentage of Lost to follow up of DR TB patients (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 12.00 18.00 14.00 5.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In Q1-2 2019, 12% (35/285) of DR-TB patients enrolled in treatment were LTFU in both Gerehu hospital Comments: and PMGH. IN00865220 ►A reduction in lost to follow up of DS TB patients (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 13.00 7.00 4.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 In (Q1-Q4) 2019, Loss To Follow Up (LTFU) rate of DS-TB (all forms of TB) was 7% for the cohort of 2018 (5% in Q1 2019, 9% in Q2 2019, 5% in Q3 2019 and 5% in Q4 2019). There had been great reduction in Comments: LTFU over the years. The WHO recommended target for the LTFU rate is less than 5%. . IN00865221 ►Number (cumulative) of DR TB patients on shorter regimen (NCD & Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/29/2020 Page 8 of 11 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Value 0.00 87.00 222.00 400.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 By 2019, a total of 201 DR-TB patients (cumulative) were started on a shorter regimen in NCD . Shorter treatment regimen with injectables is not a preferred treatment option and was discouraged due to the unavailability of DST in-country, the high turnaround time for getting results from the Queensland Mycobacterium Reference Laboratory (QMRL) of Australia, and severe side effects because of injectable second-line drugs. Most patients started on the shorter course have developed side effects associated with the injectables such as suffering from permanent hearing loss and some developing suicidal depression and psychosis. The National TB Program has adopted the recommendations from WHO consolidated guidelines on DR-TB treatment, which offers the option for an all-oral longer regimen (injectable free). Patients have a lot to benefit in terms of favourable treatment outcomes. In December 2019, the WHO announced changes to the treatment of DRTB patients without previous exposure to second-line drugs without fluoroquinolone resistance, the preferred treatment option is a shorter, all-oral, Bedaquiline containing regimen. The NTP in-collaboration with the WHO will convene a meeting with the Comments: clinicians to discuss and adopt the new changes. The new recommendations will provide an opportunity for better treatment outcomes. Note: Shorter regimen was introduced in Port Moresby General Hospital in 2016 and Gerehu hospital in 2017. Therefore, the baseline is 0 For Daru, Western Province: By the end of 2019, a total of 21 DR-TB patients had been started on a shorter regimen in Daru BMU from 2017-2018. In 2019, no DR-TB patient was enrolled in a shorter course regimen. This is due to drug resistance patterns in Daru; the unavailability of DST; and the turnaround time for getting results from QMRL. Note: The shorter regimen was introduced in Daru 2017 and suspended in 2018 due to resistance patterns. Strengthening government systems for managing its health services delivery and tuberculosis response IN00865207 ►The conduction of semi-annual review meeting which involves TB development partners and government agencies to review the progress and make the consolidated, integrated work plan and budget (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 Partner’s interventions have contributed to all four components of the NCD TB Strategic Plan (service delivery, advocacy, and health promotion, program support and coordination & oversight). In the past two years World Vision, FHI 360 and Child Fund have operated a community-based treatment supporter program in Port Moresby. Two years have passed since the introduction of the community-based TB treatment project and a review was conducted to assess progress made towards project targets, Comments: determine the cost-effectiveness of different models of community-based care implemented in NCD, assess the effectiveness of IEC activities and analyze challenges, lessons learned and provide recommendations for further strengthening of the project implementation. Due to difficulties in obtaining a PNG visa, the lead TB consultant and the unavailability of financial information from the service providers, the review will be pursued in Q1 2020. IN00865210 ►Citizens and/or communities involved in planning/implementation/evaluation of development programs (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 6/29/2020 Page 9 of 11 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) The communities are engaged in TB control through awareness, referral of presumptive TB and patient support during treatment is improving. However, evaluation of the project is done through quarterly review Comments: meetings and mainly involving NCD health, NDOH and partners. Note: Recommendation: CBOs to participate in the upcoming quarterly review meetings. IN00865213 ►Project-supported organization(s) publishing reports containing information on feedback received from citizens and/or communities and if/how this feedback has been used (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 Interviews were done in the communities during the provision of DOTS and information shared internally. Some organizations have documented community perceptions/views in quarterly bulletins, donor reports, and country human impact reports and feedback used to improve service delivery. Publication of Comments: information containing community feedback on the project will be considered in the future after the annual NCD review is finalized IN00865215 ►Timely delivery of annual report compiled by NTP (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 31-Aug-2016 31-Dec-2018 31-Dec-2019 30-Jun-2022 The write-up of the 2019 NTP Annual TB report is ongoing and once finalized in Q1 2020, it will be shared with the TWG for inputs. The final draft will be submitted to the senior executive management of the Comments: NDOH for endorsement. The final report will be made available to partners in Q3 2020. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P160947 IDA-60670 Effective USD 15.00 15.00 0.00 4.15 11.19 27% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P160947 IDA-60670 Effective 31-May-2017 19-Jul-2017 25-Sep-2017 30-Jun-2022 30-Jun-2022 Cumulative Disbursements 6/29/2020 Page 10 of 11 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) 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) There are no related projects. 6/29/2020 Page 11 of 11