The World Bank Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) REPORT NO.: RES35830 DOCUMENT OF THE WORLD BANK RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF CAMBODIA HEALTH EQUITY AND QUALITY IMPROVEMENT PROJECT (H-EQIP) APPROVED ON MAY 19, 2016 TO KINGDOM OF CAMBODIA HEALTH, NUTRITION & POPULATION EAST ASIA AND PACIFIC Regional Vice President: Victoria Kwakwa Country Director: Ellen A. Goldstein Senior Global Practice Director: Timothy Grant Evans Practice Manager/Manager: Enis Baris Task Team Leader: Somil Nagpal, Nareth Ly The World Bank Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) I. BASIC DATA Product Information Project ID Financing Instrument P157291 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 19-May-2016 30-Jun-2021 Organizations Borrower Responsible Agency Kingdom of Cambodia Ministry of Health,Ministry of Health Project Development Objective (PDO) Original PDO To improve access to quality health services for the targeted population groups with protection against impoverishment due to the cost of health services in the Kingdom of Cambodia. Current PDO To improve access to quality health services for the targeted population groups, with protection against impoverishment due to the cost of health services in the Kingdom of Cambodia, and to provide immediate and effective response in case of an eligible crisis or emergency. Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-58130 19-May-2016 26-Aug-2016 09-Nov-2016 30-Jun-2021 30.00 10.36 19.83 TF-A2562 19-May-2016 15-Sep-2016 15-Sep-2016 30-Jun-2020 1.00 .24 .76 TF-A3114 19-May-2016 26-Aug-2016 09-Nov-2016 30-Jun-2021 37.00 17.26 19.74 The World Bank Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. SUMMARY OF PROJECT STATUS AND PROPOSED CHANGES The Health Equity and Quality Improvement Project (H-EQIP) is on track towards achieving its PDOs and implementation is progressing well. Health Equity Fund (HEF) monitoring role was successfully transferred to Payment Certification Agency (PCA). Payment for HEF and Service Delivery Grant (SDG) is consistently on track. Despite some delays in rolling out the SDG, two third of the health facilities nationwide are being assessed on quarterly basis and the remaining health facilities are expected to be part of this assessment system from July 2019. An Additional Financing (AF) of US$6 million funded by the Multi-Donor Trust Fund for H-EQIP was approved on December 19, 2018 and is aimed to further enhance the project impact through three new Disbursement Linked Indicators (DLIs) focusing on non-communicable diseases (cervical cancer screening and treatment, diabetes and hypertension) and to support long-term family planning. The AF also took the opportunity to restructure some of the indicators and DLI definitions/targets to address the implementation bottleneck. The PDO has also been modified to read as “To improve access to quality health services for the targeted population groups, with protection against impoverishment due to the cost of health services in the Kingdom of Cambodia, and to provide immediate and effective response in case of an eligible crisis or emergency” to reflect the CERC component of the IDA project. However, there are no emergency activities to be financed from PHRD and this PDO modification only pertains to IDA financing. This project has benefited from a focused support on its M&E activities through the complementary financing of US$1 million supported by the Japan Policy Human Resource Development Fund (PHRD) (TF0A2562). The PHRD contributes to the overall PDO by focusing on strengthening the M&E planning, coordination and review processes in the health sector. The grant particularly supports improvement of quality of data available to the Ministry of Health to promote evidence-based decision making for improved monitoring and strengthened management of the health system. This system was designed in detail during the first year of the project and named as the National Quality Enhancement Monitoring (NQEM) Program, which involves a quarterly assessment of each health facility by their supervisory levels, and objective scoring on a range of quality and performance indicators, validated by an independent verification process, and rolled out 6 months after project effectiveness, in May 2017. Despite the initial delay in the rollout of the country’s NQEM Program, the grant has immensely contributed to the improvement of monitoring quality of services. It was also increasingly clear to the government that such an elaborate system cannot be sustained using simple paper and excel-based tools and thus will benefit from a structured information system. However, the government has expressed its wish to wait until the system has stabilized to initiate this switchover to an ICT-based information system, which will improve the reliability of the data, as well as allow much better data analysis to inform decision making. This ICT system will reduce the need for frequent M&E meetings and workshops that were earlier envisaged under the project, and provide a sustainable, robust monitoring system which is in line with the objectives of PHRD PRIME Window. Further, there is no reduction in the capacity building that was envisaged- in fact, the number of assessors to be trained under the NQEM Program has increased in the recent H-EQIP additional financing with a DLI on “two The World Bank Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) additional assessors to be trained in each operational district”. The funds for ongoing training needs are now being sourced from domestic resources, particularly using the funds from the country’s achievements from DLIs. In view of the above, the team proposes a reallocation of expenditure categories to include this activity under Component 2 “Data Quality Monitoring and Capacity Building in M&E”. Proposed reallocation across expenditure categories is summarized under "Reallocation" under "Proposed Changes". Bottomline, the changes entail an increase in Category 1 "Goods and consulting services" as indicated in the table under Section II. Detailed Changes to accommodate the cost for an ICT firm to develop the more structured, sustainable monitoring system using ICT, while reducing by the equivalent amount the costs for training and workshops. As stated earlier, the Royal Government of Cambodia (RGC), in their effort to strengthen the M&E capacity, has mobilized funds to strengthen their training through its own domestic resources, as well as the DLI money earned under the project. Therefore, the effort to build M&E recipient capacity is in no way reduced; on the contrary strengthened but by using other resources available to RGC. II. DETAILED CHANGES REALLOCATION BETWEEN DISBURSEMENT CATEGORIES Current Current Actuals + Proposed Disbursement % Ln/Cr/TF Expenditure Allocation Committed Allocation (Type Total) Category Current Proposed TF-A2562- TFA2562 - GDS 124,154.00 300.00 678,400.00 100.00 100.00 001 & CS Currency: TFA2562 - USD 573,438.00 9,467.10 202,847.00 100.00 100.00 TRAINING TFA2562 - OPERATING 302,408.00 4,500.00 118,753.00 100.00 100.00 COSTS The World Bank Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Total 1,000,000.00 14,267.10 1,000,000.00