The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Health System Resiliency Strengthening (P150481) MIDDLE EAST AND NORTH AFRICA | West Bank and Gaza | Health, Nutrition & Population Global Practice | Special Financing | Investment Project Financing | FY 2015 | Seq No: 13 | ARCHIVED on 22-Mar-2019 | ISR36152 | Implementing Agencies: Ministry of Health, Ministry of Finance, World Health Organization, USAID/Intrahealth Project Key Dates Key Project Dates Bank Approval Date: 21-Jan-2015 Effectiveness Date: 16-Feb-2015 Planned Mid Term Review Date: 15-May-2017 Actual Mid-Term Review Date: 17-Jul-2017 Original Closing Date: 30-Jun-2020 Revised Closing Date: 30-Jun-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project PDO is to support the Palestinian Authority in securing continuity in healthcare service delivery and building its resilience to withstand future surge in demand for effective healthcare coverage. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Emergency and Rapid Response Window:(Cost $2.00 M) Component 2: Rationalizing Outside Medical Referrals:(Cost $3.50 M) Component 3: Supporting health coverage to strengthen sector resilience:(Cost $2.00 M) Component 4: Project Management and Capacity Building:(Cost $1.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Unsatisfactory Overall Risk Rating Substantial High Implementation Status and Key Decisions Overall the Health System Resiliency Strengthening project has made progress, and more than half of resources have been disbursed (USD 4.9 Million out of a total of USD 8.5 Million – 58%). However, the growth rate of Outside Medical Referral expenditures has shown an unexpected hike over the past three years due to a combination of factors including lack of harmonized standards, repressed demand, and hikes in prices by providers. Despite strong implementation support, the implementation of activities to strengthen the Services Purchasing Unit (SPU) at the Ministry of Health (MOH) has continued to lag. The ratings for progress toward achievement of the PDO and overall implementation have been downgraded to “Moderately Unsatisfactory”. 3/22/2019 Page 1 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Component 1: Emergency and Rapid Response Window All the funds were disbursed to finance non-medical expenditures to operate and maintain the MOH facilities in the Gaza strips. The World Bank team, together with the MOH, is closely monitoring service delivery and access to care in Gaza, specifically the possible disruption of health care service delivery. This is due to the increasing number of casualties and lack of basic commodities (such as electricity and medicines). Component 2: Rationalizing Outside Medical Referrals The project supports the MOH to improve operational and technical capacity of the SPU, which manages medical referrals within and/or outside of Palestinian Territory. Despite continuous implementation support from the World Bank team, implementation of the activities to strengthen the SPU functions continue to be delayed. Thus, the MOH and the World Bank team decided to focus on prioritized activities to improve the MOH capacity to effectively harness the growth of expenditures from outside medical referrals. The World Bank team is closely working with the SPU to stay on track for agreed activities and their implementation. Component 3: Supporting Health Coverage to Strengthen Sector Resilience The Palestinian National Institute of Public Health (an implementing agency contracted by the MOH) has made progress on each sub-component, namely health financing, human resources for health and family health practice. The World Bank team is closely monitoring the progress of the implementation and providing necessary technical guidance. Based on an assessment of the implementation progress, the World Bank would recommend modifications to sub-components activities as necessary. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- High High Macroeconomic -- High High Sector Strategies and Policies -- High High Technical Design of Project or Program -- High High Institutional Capacity for Implementation and Sustainability -- High High Fiduciary -- Substantial Substantial Environment and Social -- Substantial Substantial Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial High Results PDO Indicators by Objectives / Outcomes Project Development Objectives IN00674583 ►Utilization rates (out-patient, emergency and obstetrics) in the hospitals of Shifa, Rafedia and Alia Hospital do not deteriorate or improve up to 10% compared to a baseline end-September, 2014 (Text, Custom) 3/22/2019 Page 2 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Baseline Actual (Previous) Actual (Current) End Target Shifa occupancy: 94.6%, Rafedia occupancy: Shifa occupancy: 89%, 95.77%; Rafedia occupancy: Alia occupancy: 85%, Alia occupancy: Shifa occupancy: 89%, 141.2% 136% Rafedia occupancy: 85% Obstetrics Shifa:154% Obstetrics Shifa: 76% Obstetrics Shifa: 76% Obstetrics Rafedia: - Obstetrics Rafedia: Obsetrics Rafedia: 94% 85.3% Value -- 94% - Obstetrics Alia: Outpatient Shifa: Obstetrics Alia: 127% 105% 578,646 Outpatient Shifa: OC= Outpatient Shifa: Outpatient Rafedia: 174,900, ER= 281,849 578,646 - Outpatient 163,262 Oupatient Rafedia: Rafedia: 163,262 - 61,434 Outpatient Alia: Outpatient Alia: 102046 OC=104,655, ER=99,902 Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 IN00674584 ►Average annual growth of total expenditure in OMRs of a four-year period lower than the proposed baseline which is the period 2012-2015 (<13.19%) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 13.19% -- 13.19% <13.19% Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 IN00674585 ►Gap in geographic equity for referral cost (between the West Bank and Gaza) reduced by 80 percent relative to baseline (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.7:1 -- 1.7:1 1:15:1 Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 Overall Comments PDO Actual data of indicators are currently being reassessed. Updated data would be available in the next Implementation Status Report. Intermediate Results Indicators by Components Intermediate Results IN00674641 ►Utilization rates (outpatient, emergency, and obstetrics) in the hospitals of Shifa, Rafedia and Alia do not deteriorate or improve by up to 10% compared to a baseline end September 2014 (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Shifa occupancy:89% - Shifa occupancy: Same ratio as baseline Value -- Nasser occupancy: 74% 94.6% or improve up to 10% 3/22/2019 Page 3 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) European Gaza Hospital: Nasser occupancy: 79% 122% European Gaza Hospital occupancy: 94% Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 IN00674642 ►Referral protocols and procedures for the ten costliest conditions defined and rendered operational (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.00 8.00 10.00 Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 IN00674643 ►A consolidated Government Health Information System (HIS) for referrals and health insurance is operational (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target A web-based system operational in all Value 0.00 -- not operational hospitals taking referrals Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 IN00674644 ►HIS operational in selected hospitals (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8.00 12.00 10.00 Date 25-Jan-2015 05-Jun-2018 26-Feb-2019 31-Dec-2019 Achieved as of December 2018. Comments: IN00674645 ►Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 2.00 Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 Achieved as of June 2018. Comments: IN00674646 Direct project beneficiaries (no), of which female (%) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 53.00 45.50 53.00 IN00674647 ►New referral contracts/ MOUs negotiated with all outside providers (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 16.00 30.00 3/22/2019 Page 4 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 IN00674648 ►Purchasing agency (either independent or part of the MOH) created, staffed and made operational (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- Functional Functional Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 Achieved as of December 2018. Comments: IN00674649 ►People with access to a basic package of health, nutrition or reproductive health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 90.00 90.00 90.00 Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 IN00674650 Direct project beneficiaries (no), of which female (%) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 45.00 50.00 50.00 Date 25-Jan-2015 05-Jun-2018 26-Feb-2019 31-Dec-2019 IN00674651 ►External audit (medical and financial) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Financial audit report for 2017 has been cleared and approved by the Ministry of Finance and Planning. Value Not available -- Medical audit for Functional referrals at the SPU were conducted by medical auditors and case managers as of December 2018. Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 IN00674652 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 510.00 635.00 500.00 Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 Achieved as of December 2018 Comments: IN00674653 ►Grievance and Redress Mechanism (GRM) for OMRs and access to Health Care designed and fully operational by end of the project (Text, Custom) 3/22/2019 Page 5 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Baseline Actual (Previous) Actual (Current) End Target As of December 2018, a patient can document a complaint on the complaint website which is a part of the MOH website. The MOH reports the number of received Value Not available -- Fully functional complaints to Annual Complaint Report, which is published by the General Secretariat of the Council of Ministers, General Directorate of Complaints. Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 IN00674654 ►Communciation strategy on UHC developed and consultation workshops conducted to promote the concept of citizens' engagement (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target As of December 2018, Communication Strategy was developed, following by consultation One consultation Value 0.00 -- workshops with key workshop conducted MOH departments (referral, insurance, complaint, media and public relations) Date 25-Jan-2015 15-Oct-2018 26-Feb-2019 31-Dec-2019 Achieved as of December 2018. Comments: IN00674655 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 175,554.00 175,554.00 526,662.00 Date 01-Jan-2017 31-Dec-2017 31-Dec-2017 31-Dec-2019 IN00674656 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 138,116.00 138,116.00 414,348.00 Date 01-Jan-2017 31-Dec-2017 31-Dec-2017 31-Dec-2019 IN00674657 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 37,438.00 37,438.00 112,314.00 3/22/2019 Page 6 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Date 01-Jan-2017 31-Dec-2017 31-Dec-2017 31-Dec-2019 Overall Comments IR Actual data of indicators are currently being reassessed. Updated data would be available in the next Implementation Status Report. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P150481 TF-18986 Effective USD 8.50 8.50 0.00 5.07 3.43 60% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P150481 TF-18986 Effective 04-Feb-2015 04-Feb-2015 16-Feb-2015 30-Jun-2020 30-Jun-2020 Cumulative Disbursements 3/22/2019 Page 7 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Restructuring History Level 2 Approved on 07-Sep-2015 ,Level 2 Approved on 17-Jan-2018 Related Project(s) There are no related projects. 3/22/2019 Page 8 of 8