The World Bank Implementation Status & Results Report Mizoram Health Systems Strengthening Project (P173958) Mizoram Health Systems Strengthening Project (P173958) SOUTH ASIA | India | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2021 | Seq No: 1 | ARCHIVED on 24-Aug-2021 | ISR47821 | Implementing Agencies: India (Department of Economic Affairs, Government of India), Health and Family Welfare Department, Government of Mizoram Key Dates Key Project Dates Bank Approval Date: 31-Mar-2021 Effectiveness Date: 13-Jul-2021 Planned Mid Term Review Date: 30-Nov-2023 Actual Mid-Term Review Date: Original Closing Date: 31-Mar-2026 Revised Closing Date: 31-Mar-2026 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) Project Development Objective (PDO) is to improve management capacity and quality of health services in Mizoram. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1. Strengthen management and accountability through Internal Performance Agreements (IPAs):(Cost $13.50 M) Component 2: Improve design and management of state health insurance programs.:(Cost $2.50 M) Component 3: Enhance quality of health services and support innovations.:(Cost $15.92 M) Component 4: Contingent Emergency Response Component. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO -- Satisfactory Overall Implementation Progress (IP) -- Satisfactory Overall Risk Rating -- Substantial Implementation Status and Key Decisions The Mizoram Health Systems Strengthening Project (MHSSP) is scheduled to be implemented between 2021 and 2026. The project was signed on June 17, 2021 and declared effective on July 13, 2021. PMU has signed the contracts for the key consultancy services and also for the civil works that are critical to project. The work in all three components of the project has begun - Designing of component 1 that involved Internal Performance Agreement (IPA) is complete; the technical work for health insurance under component 2 has been initiated, and the project team along with project management consultant and technical agency (PMTA) has developed the road map for quality assurance activities that are part of component 3. The project is planned to be formally launched by the state in the third week of August 2021. 8/24/2021 Page 1 of 8 The World Bank Implementation Status & Results Report Mizoram Health Systems Strengthening Project (P173958) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate -- Moderate Macroeconomic Moderate -- Moderate Sector Strategies and Policies Moderate -- Moderate Technical Design of Project or Program Substantial -- Substantial Institutional Capacity for Implementation and Substantial -- Substantial Sustainability Fiduciary Substantial -- Substantial Environment and Social Moderate -- Moderate Stakeholders Moderate -- Moderate Other -- -- -- Overall Substantial -- Substantial Results PDO Indicators by Objectives / Outcomes To improve management capacity and quality of health services in Mizoram. IN01026423 ►The percentage point increase in average performance score in targeted administrative units as per internal performance agreement from baseline. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 20.00 Date 05-Apr-2021 -- 10-Aug-2021 31-Mar-2026 Numerator: average performance score in targeted units – baseline average performance score *100 Comments: Target= 15 administrative units [5 State level and 10 district level] IN01026424 ►Cumulative Number of districts hospitals which are NQAS certified (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 -- 1.00 8.00 Date 05-Apr-2021 -- 10-Aug-2021 31-Mar-2026 8/24/2021 Page 2 of 8 The World Bank Implementation Status & Results Report Mizoram Health Systems Strengthening Project (P173958) Numerator: Number of Targeted Health Facilities who have received unconditional national quality Comments: assurance certificate. Target= 9 District hospitals IN01026425 ►The percentage point increase in average quality index score for CHCs and PHC from baseline. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 20.00 Date 05-Apr-2021 -- 10-Aug-2021 31-Mar-2026 Numerator: average Quality Index score in targeted health units – baseline average quality index score Comments: *100 Target= 9 DH + 2 SDH + 9 CHC + 39 PHC IN01026426 ►The percentage point increase in score among those who participated in clinical vignettes. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 25.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: average clinical vignette score core in health units (DH + CHC + PHC) by the state – baseline Comments: average clinical vignette score *100 Target= Doctors and Nurses in all notified health facilities (9DH + 2 SDH + 9 CHC + 63 PHC) IN01026427 ►Improve management and efficiency of Health insurance program by Convergence between the MHCS and PMJAY. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Fragmented benefit Fragmented benefit package. package. Fragmented Fragmented operational ISO certification of operational systems systems and processes. insurance agency and Value -- and processes. State scheme is not Integrated beneficiary State scheme is not cashless and is paper- database. cashless and is paper- based. based. Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Year-1: Unified benefit package (the benefits may differ based on the nature of subscription, but will be under single system) Year-2: Aligning operational processes under MHCs (paper-based) with the PM-JAY (paperless & cashless) leveraging technology and IT-based integrated architecture. Year3: Approval and Comments: notification of integrated standard protocols and operating procedures for all schemes Year 4: (a) Training of state and district level staff on new system, & (b) integrated verified beneficiary database Year-5: ISO certification of the Mizoram Health Care Society Intermediate Results Indicators by Components Strengthen Management and Accountability through Internal Performance Agreements. IN01026428 ►Percentage of administrative units and facilities signed internal performance agreement. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 8/24/2021 Page 3 of 8 The World Bank Implementation Status & Results Report Mizoram Health Systems Strengthening Project (P173958) Value 0.00 -- 0.00 100.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Number of administrative units and targeted health facilities which have singed the internal Comments: performance contract Denominator: state level- 5 Units (HR, Health Insurance, Bio Medical waste, Quality Assurance, Community mobilisation) 10 Districts, 9 District Hospitals, 2 SDH, 9 CHC, 39 PHC IN01026431 ►Percentage of internal performance agreements reviewed as per the operational manual. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 100.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Number of administrative units and targeted health facilities which have internal performance contract reviewed Denominator: Number of administrative units and targeted health facilities that has Comments: signed the internal performance contract Target: 5 State+ 9 Health District + 9 DH+2 SDH +9CHC+63 PHC IN01026434 ►Percentage of targeted facilities and administrative units that receive performance payment, as per operations manual. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 100.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Number of targeted administrative units and facilities having quality assessments done Comments: through Quality Index tool and paid within 60 days of the end of the quarter Denominator: Number of Targeted Health Facilities IN01026437 ►Percentage point increase in average patient satisfaction score in targeted health facilities. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 25.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: average patient satisfaction score- patient satisfaction score in baseline *100 Targeted Comments: facilities: 9 District Hospitals, 2 SDH, 9 CHC, 39 PHC IN01026440 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 14,753.00 -- 14,753.00 88,630.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 IN01026443 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 14,753.00 -- 14,753.00 88,603.00 8/24/2021 Page 4 of 8 The World Bank Implementation Status & Results Report Mizoram Health Systems Strengthening Project (P173958) Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 IN01026444 ►Percentage point decrease of targeted health facilities reported stock-out of essential drugs. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 10.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Number of targeted health facilities having stockout essential medicines, as reported in the Comments: HMIS (none reporting to be considered as stockout) Denominator: Number of Targeted Health Facilities Improve Design and Management of the State Health Insurance Programs. IN01026429 ►Percentage households covered under health insurance scheme. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 -- 50.00 70.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Number of Families enrolled and given smart card for health insurance*100 Denominator: Comments: Estimated Number of families in the state at the beginning of the project IN01026432 ►Percentage point increase of women headed households covered under health insurance scheme. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 20.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Number of Families (headed by women) enrolled and given smart card for health Comments: insurance*100 Denominator: Total number of families enrolled in the health insurance IN01026435 ►Percentage of claims for which post payment medical audit has been done. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 6.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Number of Claims for which post payment audit report is submitted in last quarter Comments: Denominator: Total number of claims submitted in last quarter IN01026438 ►Percentage of local fund utilization (including performance grants and Insurance reimbursements) in targeted hospitals. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 80.00 8/24/2021 Page 5 of 8 The World Bank Implementation Status & Results Report Mizoram Health Systems Strengthening Project (P173958) Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Total booked expenditure Denominator: Total funds received* by the targeted facility during Comments: last quarter * Funds received from NHM, State, Insurance, world bank project and user fee, if any IN01026441 ►Percentage of claims settled within agreed turnaround time. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 -- 50.00 90.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Number of claims for which the money has been transferred to beneficiary Denominator: Comments: Number of claims submitted Target: 30 days turnaround time Enhance Quality of Health Services and Support Innovations. IN01026430 ►Percentage of medical doctors and nurses from targeted facilities participated in clinical vignettes. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 90.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Total number of Doctors and Nurses in the targeted health facilities who have received at Comments: least one clinical vignette score in the last quarter Denominator: Total number of permanent doctors and nurses + 50% of contractual doctors and nurses in targeted health facilities in the same quarter IN01026433 ►Average score for bio medical waste management in targeted health facilities at district, CHC and PHC level. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 30.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Biomedical waste score* under Quality Index in targeted health facility Denominator: Number of Targeted Health Facilities DH-9, SDH-2, CHC-9, PHC-39 * Bio medical waste management: Color coded bins with cover [one each in OPD, each Ward, OT, Dressing, Injection room, emergency, labor Comments: room and lab], Needle cutter, Hypochlorite solution in laboratory. Mops with bucket and disinfectant. [separate for each OT, labor room] and general patient care including ward. Daily Collection of waste and mopping [schedule]. Treatment of infectious waste: [hypochlorite for sharps], microwave/autoclave. Functional sharps pit and deep burial pit with cover [no spillage outside] (All or None). IN01026436 ►Percentage of targeted facilities have developed / revised quality improvement plan in last quarter. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 95.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Number of targeted health facilities which have submitted the annual plan and all quarterly Comments: revisions Denominator: Number of Targeted Health Facilities; DH-9, SDH-2, CHC-9, PHC-39 IN01026439 8/24/2021 Page 6 of 8 The World Bank Implementation Status & Results Report Mizoram Health Systems Strengthening Project (P173958) ►Percentage of targeted facilities where quality scoring was done by higher level in last quarter. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 95.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Number of targeted health facilities which are visited and scored using Quality Index tool by Comments: district quality management team and showing at least 10% point improvement from the previous quarter performance Denominator: Number of Targeted Health Facilities, DH-9, SDH-2, CHC-9, PHC-39 IN01026442 ►Percentage of targeted facilities trained on public health system emergency response. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 100.00 Date 05-Apr-2021 -- 10-Aug-2021 03-Apr-2026 Numerator: Number of targeted health facilities trained in responding to natural disaster and disease Comments: outbreaks/epidemics Denominator: Number of Targeted Health Facilities; DH-9, SDH-2, CHC-9, PHC-39 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173958 IBRD-92270 Effective USD 32.00 32.00 0.00 0.08 31.92 0.3% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173958 IBRD-92270 Effective 31-Mar-2021 17-Jun-2021 13-Jul-2021 31-Mar-2026 31-Mar-2026 Cumulative Disbursements 8/24/2021 Page 7 of 8 The World Bank Implementation Status & Results Report Mizoram Health Systems Strengthening Project (P173958) 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. 8/24/2021 Page 8 of 8