The World Bank Implementation Status & Results Report AFR RI-Southern Africa Tuberculosis and Health Systems Support Project (P155658) AFR RI-Southern Africa Tuberculosis and Health Systems Support Project (P155658) AFRICA EAST | Eastern Africa | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2016 | Seq No: 8 | ARCHIVED on 27-Oct-2020 | ISR43738 | Implementing Agencies: Republic of Mozambique, Ministry of Health, Ministry of Health, Kingdom of Lesotho, Ministry of Health, Republic of Zambia, Ministry of Health, Republic of Malawi, Ministry of Finance, Ministry of Finance, African Union Development Agency (AUDA-NEPAD), East, Central and Southern African Health Community (ECSA-HC) Key Dates Key Project Dates Bank Approval Date: 26-May-2016 Effectiveness Date: 05-Dec-2016 Planned Mid Term Review Date: 22-Apr-2019 Actual Mid-Term Review Date: 22-Apr-2019 Original Closing Date: 31-Dec-2021 Revised Closing Date: 31-Dec-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) A. Proposed Development Objective(s) The overall objectives of the project are to: (i) improve coverage and quality of TB controland occupational lung disease services in targeted geographic areas of the participating countries; and (ii) strengthen regionalcapacity to manage the burden of TB and occupational diseases. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) The overall objectives of the project are to: (i) improve coverage and quality of TB control and occupational lung disease services in targeted geographic areas of the participating countries; and (ii) strengthen regional capacity to manage the burden of TB and occupational lung diseases; (iii) strengthen country-level and cross-border preparedness and response to disease outbreaks Components Table Name Innovative Prevention, Detection and Treatment of TB:(Cost $61.08 M) Regional Capacity for Disease Surveillance, and Diagnostics and Management of TB and Occupational Lung Diseases:(Cost $61.80 M) Regional Learning and Innovation, and Project Management:(Cost $55.12 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial 10/27/2020 Page 1 of 10 The World Bank Implementation Status & Results Report AFR RI-Southern Africa Tuberculosis and Health Systems Support Project (P155658) Implementation Status and Key Decisions The Southern Africa TB and Health Systems Support Project (SATBHSSP) continues to make strong progress towards achieving its Project Development Objectives (PDO) in all participating countries (Lesotho, Malawi, Mozambique, and Zambia). The 2019 performance report indicated that the Project has achieved the annual targets for three out of five (60 percent) project outcome indicators, and for 12 out of 15 intermediate outcome indicators (80%). The Project has completed two restructurings and Additional Financing in the last six months. An additional US$59 million was added to the Project to scale up interventions in Malawi, Lesotho, and at the regional level, for the East, Central and Southern African Health Community and the African Union Development Agency—New Partnership for Africa’s Development. A significant portion of the additional resources are intended to strengthen national and regional response to COVID-19, as well as roll out critical civil works. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Moderate Moderate Macroeconomic Moderate Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Substantial Substantial Substantial Other Moderate Moderate Moderate Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improve coverage and quality of TB control and occupational lung disease services in targeted areas IN00901031 ►TB case notification in target geographic areas (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 85,391.00 99,415.00 45,411.00 58,324.00 Date 31-Dec-2014 08-Apr-2020 14-Oct-2020 29-Dec-2023 10/27/2020 Page 2 of 10 The World Bank Implementation Status & Results Report AFR RI-Southern Africa Tuberculosis and Health Systems Support Project (P155658) This indicator is on track. In aggregate, the achievement level for 2020 partial year (January to June) was 45,411 almost halfway towards the annual target of 109,359. However all countries have noted the Comments: declining incidence of TB at the national level as a contributing factor for TB notification trends. IN00901034 ►TB Treatment success rate among new and relapse TB cases in target geographic areas (percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 83.00 87.00 87.75 93.00 Date 31-Dec-2014 08-Apr-2020 14-Oct-2020 29-Dec-2023 This is an annual target. This indicator--at the regional level--is on track. The 2020 target for this indicator is 89.5 percent versus baseline of 83 percent. So far, the average treatment success rate across the four countries is 87.75 percent compared with the annual target of 89 percent. The highest performance is in Mozambique 93 percent, followed by Malawi and Zambia with 90 percent each (surpassing national annual target), while Comments: Lesotho has the lowest rate at 78 percent (falling below national annual target, although there has been improvement from the baseline of 71%). Achieving the regional targets--over the next 3.5 years--on this indicator will require significant improvements in treatment success rate in Lesotho as well as sustained momentum in all the other three countries. IN00901035 ►TB cases identified through active TB case finding (screening) among TB vulnerable population in target geographic areas (Number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5,239.00 11,523.00 7,731.00 9,170.00 Date 31-Dec-2014 08-Apr-2020 14-Oct-2020 29-Dec-2023 This is measured as an annual target. This indicator is on track. The achievement of 7731 is more than half the annual target of 13168. COVID- 19 is not expected to have a significant impact on ongoing interventions for community-based screening to identify active TB cases. The low number of cases identified is attributable to declining incidence of TB in the sub region, coupled with the design of interventions to screen presumptive cases and increase yield on sputum and specimen Comments: collected. Given declining incidence, identifying new cases takes much more effort and will require adaptation of approach to better refine screening and case finding techniques. For some countries, they are now intensifying efforts in identifying the most high-risk groups, like prisoners, to increase TB detection rates. This issue was discussed during the Regional Advisory Committee meeting of the Project and the indicator was revised during the MTR to capture all cases identified among TB vulnerable population. IN00901036 ►Proportion of pulmonary TB cases that are bacteriologically confirmed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 53.30 56.30 55.00 68.30 Date 07-Feb-2018 07-Feb-2020 14-Oct-2020 29-Dec-2023 This is measured as an annual target. Comments: IN00901037 ►Number of miners and ex-miners successfully screened for occupational lung diseases (Number, Custom) 10/27/2020 Page 3 of 10 The World Bank Implementation Status & Results Report AFR RI-Southern Africa Tuberculosis and Health Systems Support Project (P155658) Baseline Actual (Previous) Actual (Current) End Target Value 45,453.00 45,453.00 39,428.00 50,050.00 Date 24-Aug-2019 08-Apr-2020 14-Oct-2020 29-Dec-2023 This is measured as an annual target. Comments: Strengthen regional capacity to manage the burden of TB and occupational diseases IN00901032 ►Number of project supported laboratories compliant with regionally harmonized SOPs for surveillance of MDR-TB (number) – national and sub national levels (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 58.00 105.00 67.00 116.00 Date 31-Dec-2014 08-Apr-2020 14-Oct-2020 29-Dec-2023 This is measured as an annual target. Comments: Strengthen country-level and cross-border preparedness and response to disease outbreaks IN00901033 ►Number of countries with multi hazard preparedness plans developed (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.00 4.00 4.00 Date 24-Aug-2019 24-Aug-2019 14-Oct-2020 29-Dec-2023 This is a cumulative target. Comments: Overall Comments PDO All data recorded in the Results Framework are annual targets. Based on the data collected thus far, the PDO indicators are generally on track. Countries are likely to meet their annual (2020) and cumulative targets, since most of the targets are halfway achieved. It is important to note that the data provided in the Results Framework reflect performance from January 1 - June 30, 2020. Per the Project's guidelines, countries report on performance quarterly. The data for the period ending September 2020 is not yet completed for the four countries. Also, some of the actual figures reported in this ISR (June 2020) may be lower than those reported in the previous ISR (April 2020). This is because the April 2020 figures were based on the 2019 annual report. Intermediate Results Indicators by Components 10/27/2020 Page 4 of 10 The World Bank Implementation Status & Results Report AFR RI-Southern Africa Tuberculosis and Health Systems Support Project (P155658) Innovative Prevention, Detection and Treatment of TB IN00901043 ►Proportion of MDR-TB patients in target geographic areas benefitting from nutritional support during the treatment period (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.00 93.00 86.50 94.30 Date 26-Jan-2016 08-Apr-2020 14-Oct-2020 29-Dec-2023 This indicator is measured as an annual target. Comments: IN00901048 ►Proportion of TB patients satisfied with TB services as per patient exit surveys or “drop box” feedback in target geographic areas (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 83.00 96.00 95.00 90.00 Date 26-Jan-2016 08-Apr-2020 14-Oct-2020 29-Dec-2023 This indicator is measured as an annual target. Malawi (100%), Lesotho (100%), and Zambia (84%) exceeded their annual targets. Mozambique did not have any updates yet, but for 2019 was at 88%. Generally, the countries have progressively improved in Comments: customer satisfaction. However, there is no baseline or end line data for this indicator since baseline survey had not been conducted across the four countries at project preparation. The baseline and end targets will be reflected in the modified RF during restructuring. IN00901050 ►Percentage of HIV patients routinely screened for TB in targeted geographic areas in the four participating countries (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 94.00 94.00 92.00 95.30 Date 31-Dec-2015 08-Apr-2020 14-Oct-2020 29-Dec-2023 This is an annual target. Comments: IN00905810 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 2,703.00 -- 2,703.00 11,110.00 Date 16-Oct-2020 -- 16-Oct-2020 29-Dec-2023 IN00905818 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 2,703.00 -- 2,703.00 11,110.00 Date 16-Oct-2020 -- 16-Oct-2020 29-Dec-2023 10/27/2020 Page 5 of 10 The World Bank Implementation Status & Results Report AFR RI-Southern Africa Tuberculosis and Health Systems Support Project (P155658) Regional Capacity for Disease Surveillance, and Diagnostics and Management of TB and Occupational Lung Diseases IN00901044 ►Proportion of new and relapse TB patients tested using WHO-recommended diagnostics at the time of diagnosis. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 67.00 0.00 75.00 76.30 Date 24-Aug-2019 08-Apr-2020 14-Oct-2020 29-Dec-2023 At the regional level, this indicator appears to be on track, with the annual target already surpassed; however, there is relatively weak performance in Malawi with 33 percent. Zambia, Lesotho and Comments: Mozambique have above 80 percent, with Zambia achieving 100%. IN00901046 ►Number of countries scaling up Electronic Health Systems for TB case management or laboratory management (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 4.00 4.00 4.00 4.00 Date 26-Jan-2016 08-Apr-2020 14-Oct-2020 29-Dec-2023 IN00901049 ►Number of health facilities renovated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 22.00 100.00 Date 24-Aug-2019 08-Apr-2020 14-Oct-2020 29-Dec-2023 22 facilities have been renovated over the past six months (January - June, 2020). The breakdown is as follows: Lesotho, 7 facilities renovated (5 Port health clinics, 1 National TB reference lab and 1 TB Comments: reference lab at Motebang Hospital); Zambia 15 Facilities. IN00901051 ►Health facilities equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 17.00 90.00 Date 24-Aug-2019 08-Apr-2020 14-Oct-2020 29-Dec-2023 Malawi equipped 8 facilities, and Zambia equipped 9 facilities. This target is considerably behind schedule and countries are working to accelerate procurement of the equipment, within the current landscape of Comments: constrained supply chains due to COVID-19. IN00901053 ►Outbreaks for infectious diseases for which cross-border investigations undertaken (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 6.00 2.00 7.00 10/27/2020 Page 6 of 10 The World Bank Implementation Status & Results Report AFR RI-Southern Africa Tuberculosis and Health Systems Support Project (P155658) Date 31-Dec-2015 08-Apr-2020 14-Oct-2020 29-Dec-2023 This indicator only shows 2 because only two countries have reported thus far. With the ongoing COVID- Comments: 19 pandemic, we expect this number to increase in the next report. IN00901055 ►Proportion of suspected outbreaks of communicable diseases that are laboratory confirmed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 75.00 75.00 89.00 89.00 Date 29-Aug-2019 08-Apr-2020 14-Oct-2020 29-Dec-2023 IN00901057 ►Number of target labs rated 4 stars and above in SLIPTA assessment (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7.00 13.00 13.00 32.00 Date 30-Dec-2016 08-Apr-2020 14-Oct-2020 29-Dec-2023 IN00901059 ►Proportion of mines inspected at least twice a year complying with national mine health regulations (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 73.50 17.00 50.50 Date 26-Jan-2016 08-Apr-2020 14-Oct-2020 29-Dec-2023 There was a delay in mine inspections as a result of the COVID-19 pandemic. Consequently, over the last six months, most countries did not inspect mines twice. The 17 mines inspected twice, as recorded here, Comments: were from Zambia. With operations resuming in all countries, the next reporting period will record other inspections from all countries. IN00901060 ►Proportion of mines inspected at least twice a year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 21.00 21.00 14.00 65.00 Date 24-Aug-2019 08-Apr-2020 14-Oct-2020 29-Dec-2023 Again, this indicator was only recorded for Zambia since other countries did not record any mines Comments: inspected twice during the first six months of the year. Regional Learning and Innovation, and Project Management IN00901045 ►Regional operational research studies completed and findings, lessons learned disseminated effectively through national and regional platforms (ECSA-HC) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 10/27/2020 Page 7 of 10 The World Bank Implementation Status & Results Report AFR RI-Southern Africa Tuberculosis and Health Systems Support Project (P155658) Value 0.00 2.00 4.00 0.00 Date 26-Jan-2016 08-Apr-2020 14-Oct-2020 29-Dec-2023 This indicator is an annual target. No operational research studies are expected to be delivered in the last Comments: year of the Project, hence the 0 end line target. IN00901047 ►Operational research studies completed and findings disseminated through national or regional/international platforms. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 20.00 2.00 Date 24-Aug-2019 08-Apr-2020 18-Oct-2020 29-Dec-2023 IN00901052 ►Number of miners and ex-miners successfully referred for continuity of treatment for TB and other occupational lung diseases between participating countries and within participating countries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,351.00 135,035.00 4,894.00 1,645.00 Date 15-Mar-2020 08-Apr-2020 14-Oct-2020 29-Dec-2023 The methodology for measuring this target was found to be erroneous by ECSA. Hence the calculation Comments: has been revised; hence lower targets for moving forward (as compared to previous ISR). IN00901054 ►Number of personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2,030.00 2,630.00 1,087.00 570.00 Date 31-Dec-2015 08-Apr-2020 14-Oct-2020 29-Dec-2023 IN00901056 ►Regional operational research studies commissioned and findings, lessons learned disseminated effectively through national and regional platforms (NEPAD) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 1.00 0.00 Date 24-Aug-2019 08-Apr-2020 14-Oct-2020 29-Dec-2023 IN00901058 ►Number of countries in which new legislation or amendment to existing mine health and safety legislation are drafted and submitted to relevant authority (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 4.00 4.00 4.00 Date 26-Jan-2016 08-Apr-2020 14-Oct-2020 29-Dec-2023 Overall Comments IR 10/27/2020 Page 8 of 10 The World Bank Implementation Status & Results Report AFR RI-Southern Africa Tuberculosis and Health Systems Support Project (P155658) The intermediate targets are all annual targets. The data presented is for the period January-June, 2023. Based on this data, Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P155658 IDA-58220 Effective USD 15.00 15.00 0.00 13.10 1.76 88% P155658 IDA-58230 Effective USD 45.00 45.00 0.00 39.04 5.79 87% P155658 IDA-58630 Effective USD 22.50 22.50 0.00 19.38 2.75 88% P155658 IDA-58640 Effective USD 7.50 7.50 0.00 6.00 1.44 81% Not P155658 IDA-66950 USD 21.00 21.00 0.00 0.00 21.00 0% Effective P155658 IDA-D1170 Effective USD 9.50 9.50 0.00 9.47 0.00 100% P155658 IDA-D1180 Effective USD 22.50 22.50 0.00 15.34 6.92 69% Not P155658 IDA-D6590 USD 27.00 27.00 0.00 0.00 27.93 0% Effective P155658 IDA-D6600 Effective USD 3.00 3.00 0.00 0.00 3.11 0% P155658 IDA-D6610 Effective USD 5.00 5.00 0.00 0.00 5.22 0% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P155658 IDA-58220 Effective 26-May-2016 26-Jul-2016 13-Dec-2016 31-Dec-2021 31-Dec-2021 P155658 IDA-58230 Effective 26-May-2016 15-Dec-2016 23-Mar-2017 31-Dec-2021 31-Dec-2021 P155658 IDA-58630 Effective 26-May-2016 05-Sep-2016 06-Dec-2016 31-Dec-2021 31-Dec-2021 P155658 IDA-58640 Effective 26-May-2016 05-Aug-2016 05-Dec-2016 31-Dec-2021 31-Dec-2021 Not P155658 IDA-66950 19-Jun-2020 25-Aug-2020 -- 31-Dec-2023 31-Dec-2023 Effective P155658 IDA-D1170 Effective 26-May-2016 05-Aug-2016 05-Dec-2016 31-Dec-2021 31-Dec-2021 P155658 IDA-D1180 Effective 26-May-2016 05-Sep-2016 06-Dec-2016 31-Dec-2021 31-Dec-2021 Not P155658 IDA-D6590 19-Jun-2020 -- -- 31-Dec-2023 31-Dec-2023 Effective P155658 IDA-D6600 Effective 19-Jun-2020 03-Jul-2020 30-Sep-2020 31-Dec-2023 31-Dec-2023 10/27/2020 Page 9 of 10 The World Bank Implementation Status & Results Report AFR RI-Southern Africa Tuberculosis and Health Systems Support Project (P155658) P155658 IDA-D6610 Effective 19-Jun-2020 01-Jul-2020 29-Sep-2020 31-Dec-2023 31-Dec-2023 Cumulative Disbursements PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History Level Approved on 10-Apr-2020 ,Level 2 Approved on 06-May-2020 Related Project(s) P161791-Southern Africa Tuberculosis and Health Systems Support Project AF ,P173228-Southern Africa Tuberculosis and Health Systems Support Project Additional Financing 10/27/2020 Page 10 of 10