FOR OFFICIAL USE ONLY Report No: RES43930 INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT RESTRUCTURING PAPER ON A PROPOSED PROGRAM RESTRUCTURING OF PROGRAM TOWARDS ELIMINATION OF TUBERCULOSIS APPROVED ON MARCH 29, 2019 TO THE REPUBLIC OF INDIA {Health, Nutrition & Population Global Practice} {South Asia Region} Regional Vice President: Hartwig Schafer Country Director: Junaid Kamal Ahmad Regional Director: Lynne D. Sherburne-Benz The World Bank Program Towards Elimination of Tuberculosis (P167523) Practice Manager: Trina S. Haque Task Team Leader(s): Ronald U. Mutasa The World Bank Program Towards Elimination of Tuberculosis (P167523) ABBREVIATIONS AND ACRONYMS CTD Central Tuberculosis Division DBT Direct Benefit Transfer DEA Department of Economic Affairs DLI Disbursement Linked Indicator DR-TB Drug-Resistant Tuberculosis GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria GOI Government of India IVA Independent Verification Agency IBRD International Bank for Reconstruction and Development JMM Joint Monitoring Mission MOF Ministry of Finance MOHFW Ministry of Health and Family Welfare NSP National Strategic Plan NTEP National Tuberculosis Elimination Program PforR Program-for-Results PTETB Program Towards the Elimination of Tuberculosis RNTCP Revised National Tuberculosis Control Program TB Tuberculosis TSU Technical Support Unit The World Bank Program Towards Elimination of Tuberculosis (P167523) DATA SHEET (Program Towards Elimination of Tuberculosis - P167523) BASIC DATA Project ID Financing Instrument IPF Component P167523 Program-for-Results Financing No Approval Date Current Closing Date 29-Mar-2019 30-Jun-2024 Organizations Borrower Responsible Agency Republic of India Ministry of Health and Family Welfare Program Development Objective(s) To improve the coverage and quality of TB control interventions in the private and public sector in targeted states of India OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Approval Effectiveness Closing Ln/Cr/TF Signing Date Commitment Disbursed Undisbursed Date Date Date 29-Mar- IBRD-89260 27-Jun-2019 20-Aug-2019 30-Jun-2024 400.00 41.00 359.00 2019 Policy Waiver(s) Does the Program require any waivers of Bank policies applicable to Program-for-Results operations? No Page 1 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) I. PROGRAM STATUS AND RATIONALE FOR RESTRUCTURING 1. The World Bank Board approved India’s Program Towards Elimination of Tuberculosis (PTETB) on March 29, 2019. Subsequently, the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) approved a US$41.6 million grant to buy down the principal of the International Bank for Reconstruction and Development (IBRD) loan and to pay for the loan prepayment premium. On May 13, 2019, the World Bank and the GFATM entered into an Administration Agreement, setting up a Trust Fund and establishing the terms and conditions for use of the grant towards the loan principal buy-down. The PTETB became effective on August 22, 2019 and in January 2020 achieved a disbursement of 10% following the verification of prior results. The execution of the loan buy-down is proceeding smoothly, and the GFATM is working closely with the Bank team and other partners involved in India’s TB program. 2. The project has performed well in its first year. The Ministry of Health and Family Welfare (MOHFW) has made substantial progress during the first year of the PTETB and has established a solid leadership and technical team to oversee program implementation. The PTETB is supporting India to roll out the newest innovations in the National Strategic Plan (NSP) 2017-25 for TB. Through the PTETB, the Government of India (GOI) has prioritized a total of approximately US$1.3 billion (US$900 million from GOI budget and US$400 million from the Bank loan) towards high impact interventions in the four prioritized result areas. The loan serves to protect these critical investments for India and to guarantee their implementation at scale. The MOHFW has achieved eight of nine Disbursement Linked Indicator (DLI) targets set for the first year of the PTETB; the IVA conducted verification of these DLIs between July to September 2020. To verify the achievement of the eight DLIs, the IVA carried out: desk reviews of Nikshay data; phone- calls to 30,000 randomly selected TB patients in the nine states; and field visits to ten private sector and 54 public sector TB culture and DST labs. The MOHFW submitted the IVA report and disbursement claim to the Bank on October 29, 2020 for processing and the DLI approval package is under management review. 3. Progress on key outcomes: India’s PTETB is being implemented within a context of overall TB program improvements resulting from: high-level political will; a quadrupling of domestic budget allocations to the National TB Elimination Program (NTEP); massive deployment of diagnostics; roll-out of innovations, including scaled up private provider engagement; and increased procurement of anti-TB drugs. Based on the most recent IVA report, remarkable achievements were made in key TB outcome indicators in program states in 2019. For DLI 1.1, 465,920 TB cases were notified from the private sector in 2019, representing an increase of 119,001 cases from 2018. For DLI 1.2, the rate of TB treatment success in the private sector increased by 10.2 percentage points, and reached 65.2%. For DLI 3.2, 55.8% of TB patients were tested for Rifampicin susceptibility in 2019, showing a 25.4 percentage point increase from 2018. Among the non-patient, management-related DLIs, targets were achieved for: DLI 1.3, the mechanism for establishment of the Technical Support Unit; DLI 2.1, districts implementing digital signature certificate (DSC) based approval for direct benefit transfer (DBT) payments; and DLI 4.2, development of a performance-based management mechanism between the center and the targeted states. However, MOHFW’s progress on TB outcomes and momentum on institutional reform has been significantly impacted by the COVID-19 pandemic. Analysis of second quarter 2019 data and second quarter 2020 data shows a decline in TB notification of over 60%. 4. Proposed restructuring and rationale: This restructuring will extend the Year 1 timeline to achieve DLI 4.1.1: Development and approval of a multi-year National Tuberculosis Elimination Plan (NTEP) human resource plan from October 2020 to January 29, 2021. The MOHFW has made substantial progress on all other DLI targets set for Year 1, but progress on the human resource plan DLIs has been impacted by the COVID-19 pandemic. The MOHFW had made substantial progress in developing a plan for NTEP human resources, but with the onset of the COVID-19 pandemic, MOHFW repurposed national and state NTEP staff to the emergency response. Key senior MOHFW staff leading the NTEP human resources review are now leading the national COVID-19 emergency response. In addition, the planned The World Bank Program Towards Elimination of Tuberculosis (P167523) human resource assessment study, which aimed to collect qualitative and quantitative data to inform NETP human resource planning, was delayed because of COVID-19-related travel restrictions. Moreover, COVID-19 has affected TB notification patterns, as well as NTEP staff work scope and workload. Because the COVID-19 response is likely to be protracted, how the impacts of the pandemic can be addressed in the NTEP human resource plan must be explored further. All these factors have slowed progress on the development of NTEP human resource plan, and subsequent DLIs designed to bridge human resource gaps as a key NTEP institutional reform. II. DESCRIPTION OF PROPOSED CHANGES 5. Based on the above, the proposed restructuring will amend the Loan Agreement to reflect a modified timeline for the achievement of a time-bound DLI 4.1.1: Development and approval of a multi-year RNTCP human resource plan. 6. The Department of Economic Affairs (DEA) provided No Objection to proceed with the restructuring on October 20, 2020. Additionally, at a Tripartite Portfolio Review Meeting (TPRM) on September 22-24, 2020, the DEA provided clearance to the MOHFW to work with the Bank to complete the restructuring process in line with the MOHFW’s proposals. The proposed change to DLI to be made through this restructuring is as follows: DLI DLI Indicator Summary of Proposed Change (s) 4.1 Staffing capacity of the RNTCP strengthened: DLI 4.1.1: Development and approval of a multi-year Extension of Year 1 timelines to achieve the DLI to RNTCP human resource plan at CTD and state level to January 29, 2021 match the scale and ambition of the NSP III. SUMMARY OF CHANGES Changed Not Changed Change in Results Framework ✔ The World Bank Program Towards Elimination of Tuberculosis (P167523) Reallocation between and/or Change in DLI ✔ Change in Disbursement Estimates ✔ Change in Implementing Agency ✔ Change in Program's Development Objectives ✔ Change in Program Scope ✔ Change in Loan Closing Date(s) ✔ Change in Cancellations Proposed ✔ Change in Disbursements Arrangements ✔ Change in Systematic Operations Risk-Rating Tool ✔ (SORT) Change in Safeguard Policies Triggered ✔ Change in Legal Covenants ✔ Change in Institutional Arrangements ✔ Change in Implementation Schedule ✔ Other Change(s) ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_COMPONENTS_TABLE OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Year Current Proposed 2019 0.00 0.00 2020 41,000,000.00 125,958,429.00 2021 78,000,000.00 90,358,973.00 2022 93,000,000.00 67,407,479.00 2023 70,000,000.00 57,628,158.00 2024 62,000,000.00 58,646,960.00 2025 56,000,000.00 0.00 The World Bank Program Towards Elimination of Tuberculosis (P167523) OPS_DETAILEDCHANGES_EA_TABLE . The World Bank Program Towards Elimination of Tuberculosis (P167523) ANNEX 1: RESULTS FRAMEWORK . . Results framework Program Development Objectives(s) To improve the coverage and quality of TB control interventions in the private and public sector in targeted states of India Program Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 4 To imp the coverage & quality of TB control intrv in the pvt & public sec in targt states of India PDO Indicator 1- DLI 1.1: Number of private notifications, net of any 346,919.00 400,000.00 480,000.00 600,000.00 691,200.00 800,000.00 decrease in public notifications in targeted states (Annual) (Number) PDO Indicator 2- DLI 2.2: Proportion of TB patients receiving financial support via Nikshay Poshan Yojana in 0.00 0.00 targeted states (Annual, by category of DBT scheme) (Percentage) Page 6 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 4 PDO Indicator 2.1- DLI 2.2.1: Proportion of TB patients notified by public providers receiving 1st Nikshay 66.00 68.00 70.00 73.00 75.00 77.00 Poshan Yojana payment in targeted states (Annual) (Percentage) PDO Indicator 2.2- DLI 2.2.2: Proportion of TB patients notified by private providers receiving 1st Nikshay 16.00 20.00 30.00 40.00 50.00 60.00 Poshan Yojana payment in targeted states (Annual) (Percentage) PDO Indicator 3- DLI 3.1: Proportion of notified TB patients tested for Rifampicin 30.40 45.00 57.00 59.00 60.00 64.00 susceptibility in targeted states (Annual) (Percentage) PDO Indicator 4-DLI 1.2: Treatment success rate of TB patients notified by private providers in targeted states 55.00 60.00 65.00 72.00 75.00 80.00 (Annual, patients notified in prior calendar year) (Percentage) PDO Table SPACE Page 7 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) Intermediate Results Indicators by Result Areas RESULT_FRAME_TBL_IO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 4 Intermediate Results Area 1: Scaling up Private Provider Engagement Intermediate Results Indicator 1: Proportion of privately notified Pulmonary TB patients 0.00 10.00 20.00 30.00 40.00 45.00 that have microbiological confirmation in targeted states (Percentage) Intermediate Results Indicator 2-DLI 1.3: Establishment of TSUs in CTD and targeted Mechanism to contract 10 TSUs established at states to support activities TSUs developed and No TSUs CTD and state levels by N/A N/A N/A related to private sector, DBT, approved by the MOH&FW PFMS, and multi sectoral MOH&FW engagement as per agreed TOR (Text) Intermediate Results Indicator 3: Proportion of Blocks with molecular diagnostic services 15.00 18.00 21.00 24.00 27.00 30.00 operational in targeted states (Percentage) Intermediate Results Indicator 4: GOI annual expenditure on strategic purchasing under 197.00 208.00 286.00 420.00 548.00 760.00 NGO/Private Provider budget head in targeted states (million INR per year) (Number) Page 8 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 4 Intermediate Results Area 2: Rolling-out TB Patient Management and Support Interventions Intermediate Results Indicator 5: Percentage of beneficiaries out of total notified TB Patients 68.00 70.00 72.00 75.00 80.00 85.00 seeded in Nikshay within 3 months of notification. (a) Aadhaar (Percentage) Intermediate Results Indicator 5: Percentage of beneficiaries out of total notified TB Patients seeded in Nikshay within 3 33.00 40.00 45.00 50.00 60.00 70.00 months of notification. (b) Verified bank account (Percentage) Intermediate Results Indicator 6: Gender responsive Framework developed & framework for RNTCP N/A approved developed by CTD & approved by MOH&FW (Text) IRI 7: Proportion of TB patients notified by private providers for whom at least one DBT incentive payment was made 0.00 15.00 25.00 35.00 50.00 60.00 to their private providers. (Reported data for TB patients disaggregated by gender) (Percentage) Page 9 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 4 Intermediate Results Indicator 8: Proportion of beneficiaries receiving financial support (2nd 0.00 24.00 32.00 40.00 48.00 56.00 payments of Nikshay Poshan Yojana) through DBT in targeted states (Percentage) Intermediate Result Indicator 9: Treatment success rate of female TB patients notified in 0.00 15.00 30.00 40.00 50.00 60.00 targeted states in the private sector (Percentage) Intermediate Results Area 3: Strengthening Detection, Treatment and Monitoring of Drug-Resistant TB Intermediate Results Indicator 10: Proportion of DRTB centers in the targeted states with the 34.00 40.00 45.00 50.00 60.00 70.00 action plan for AIC (Percentage) Intermediate Results Indicator 11: Proportion of notified rifampicin-resistant TB cases with second-line drug- 32.00 40.00 50.00 55.00 60.00 65.00 susceptibility testing results documented within 3 months of DR-TB treatment initiation (Percentage) Intermediate Results Indicator 46.00 48.00 52.00 55.00 60.00 65.00 12: Treatment success rate Page 10 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 4 among MDR/RR-TB patients (treatment cohort) (Percentage) Intermediate Results Area 4: Strengthening RNTCP Institutional Capacity and Information Systems 13: Annual surveillance system analysis published; including data quality by district, annual Annual analysis Annual analysis Annual analysis Annual analysis state/CTD surveillance system N/A Annual analysis published published published published published evaluation, and estimates for potential under-notification and duplication (Text) Intermediate Results Indicator 14: Number of targeted states replacing paper TB registers with e-TB Nikshay adopted 0.00 3.00 5.00 8.00 8.00 8.00 real-time monitoring of notification and quality of care in at least 50% ofdistricts (Number) Intermediate Results Indicator 15-DLI 4.2: Development and implementation of a Implementation in 5 Implementation in 8 Implementation in 8 Implementation in 8 performance-based N/A Mechanism developed States States States States management mechanism between the center and the targeted states (Text) Page 11 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 4 Intermediate Results Indicator 16: Number of targeted states adopted and transitioned from 0.00 2.00 6.00 8.00 9.00 9.00 paper-based to electronic SOE generated from PFMS (Number) 17: No. of Annual TB Forum at state & national level conducted to: (i) promote citizen engagement; (ii)foster 0.00 3.00 5.00 8.00 8.00 8.00 learning within & between states; (iii)to provide a multisectoral platform for TB control (Number) IO Table SPACE Disbursement Linked Indicators Matrix DLI IN00907228 ACTION DLI 1 1.0 Revision and approval of National Guidelines for partnerships under RNTCP (Prior Result) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output No Text 16,000,000.00 0.00 Period Value Allocated Amount (USD) Formula National Guideline for Partnership 2014 in Baseline existence. Page 12 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) CTD has revised and adopted National Guidelines Prior Results 16,000,000.00 for partnerships under RNTCP Year 1 0.00 Year 2 0.00 Year 3 0.00 Year 4 0.00 Year 5 0.00 DLI IN00907229 ACTION DLI 2 1.1 Number of private notifications, net of any decrease in public notifications in Program States (Annual) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Number 70,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 346,919.00 Prior Results 0.00 USD 154 per additional patient notified Year 1 400,000.00 17,805,111.00 by private sector ne USD 154 per additional patient notified Year 2 480,000.00 10,438,978.00 by private sector ne USD 154 per additional patient notified Year 3 600,000.00 12,526,773.00 by private sector ne USD 154 per additional patient notified Year 4 691,200.00 15,032,128.00 by private sector ne Page 13 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) USD 154 per additional patient notified Year 5 800,000.00 14,197,010.00 by private sector ne DLI IN00907230 ACTION 1.2: Treatment success rate of TB patients notified by private providers in targeted states (annual, patients notified in prior DLI 3 calendar year) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Percentage 70,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 55.00 Prior Results 0.00 USD 280,000 per every 0.1 percentage Year 1 60.00 12,622,950.00 point increase from the USD 280,000 per every 0.1 percentage Year 2 65.00 17,213,115.00 point increase from the USD 280,000 per every 0.1 percentage Year 3 72.00 17,213,115.00 point increase from the USD 280,000 per every 0.1 percentage Year 4 75.00 11,475,410.00 point increase from the USD 280,000 per every 0.1 percentage Year 5 80.00 11,475,410.00 point increase from the Page 14 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) DLI IN00907231 ACTION 1.3 Establishment of a TSU in CTD & STSUs in Program States to support activities related to pvt. sector, DBT, public DLI 4 financial management system, and multi-sectorial engagement as per agreed TOR Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome No Text 20,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No TSU/STSU in place Prior Results 0.00 MOHFW has developed and approved the Year 1 5,000,000.00 mechanism to contract TSU and STSUs 1 TSU established at CTD and 9 STSUs at state level USD 1,500,000 for each TSU/STSU Year 2 15,000,000.00 by MOHFW established Year 3 0.00 Year 4 0.00 Year 5 0.00 DLI IN00907232 ACTION 2.0 Development of Nikshay modules for all four direct benefit transfer schemes (Nikshay Poshan Yojana, Tribal TB Patients DLI 5 Scheme, Pvt. Providers Scheme and Treatment Supporters Scheme)(Prior Results) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Text 10,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 15 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) Only Nikshay Poshan Yojana existing in Nikshay Baseline (Sept 2018) Modules for all four schemes (Nikshay Poshan Yojana, Tribal TB Patients Scheme, Private Providers Prior Results Scheme and Treatment Supporters Scheme) 10,000,000.00 USD 2,500,000 for each module functional in Nikshay. Modules include payment processing and confirmation of payment. Year 1 0.00 Year 2 0.00 Year 3 0.00 Year 4 0.00 Year 5 0.00 DLI IN00907233 ACTION 2.1 Proportion of districts implementing digital signature certificate-based approval process for direct benefit transfer DLI 6 payment in Program States Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 5,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 Prior Results 0.00 USD 62,500 per every 1 percentage Year 1 20.00 1,250,000.00 point increase from the pr Page 16 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) USD 62,500 per every 1 percentage Year 2 40.00 1,250,000.00 point increase from the pr USD 62,500 per every 1 percentage Year 3 60.00 1,250,000.00 point increase from the pr USD 62,500 per every 1 percentage Year 4 80.00 1,250,000.00 point increase from the pr Year 5 0.00 DLI IN00907234 ACTION 2.2.1 Proportion of TB patients notified by public providers receiving the 1st Nikshay Poshan Yojana payment in Program DLI 7 States (Annual) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Percentage 23,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 66.00 Prior Results 0.00 USD 2090909 per every 1 percentage Year 1 68.00 7,406,780.00 point increase from the p USD 2090909 per every 1 percentage Year 2 70.00 3,898,305.00 point increase from the p USD 2090909 per every 1 percentage Year 3 73.00 3,898,305.00 point increase from the p USD 2090909 per every 1 percentage Year 4 75.00 3,898,305.00 point increase from the p USD 2090909 per every 1 percentage Year 5 77.00 3,898,305.00 point increase from the p Page 17 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) DLI IN00907235 ACTION 2.2.2 Proportion of TB patients notified by private providers receiving the 1st Nikshay Poshan Yojana payment in Program DLI 8 States (Annual) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Percentage 22,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 16.00 Prior Results 0.00 USD 500,000 per every 1 percentage Year 1 20.00 3,666,666.00 point increase from the p USD 500,000 per every 1 percentage Year 2 30.00 3,666,666.00 point increase from the p USD 500,000 per every 1 percentage Year 3 40.00 3,666,666.00 point increase from the p USD 500,000 per every 1 percentage Year 4 50.00 7,333,336.00 point increase from the p USD 500,000 per every 1 percentage Year 5 60.00 3,666,666.00 point increase from the p DLI IN00907236 ACTION DLI 9 3.1 Proportion of notified TB patients tested for rifampicin susceptibility in Program States (Annual) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Percentage 70,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 18 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) Baseline 30.40 Prior Results 0.00 USD 208,333 per every 0.1 percentage Year 1 45.00 11,666,667.00 point increase from the USD 208,333 per every 0.1 percentage Year 2 57.00 23,333,332.00 point increase from the USD 208,333 per every 0.1 percentage Year 3 59.00 11,666,667.00 point increase from the USD 208,333 per every 0.1 percentage Year 4 60.00 11,666,667.00 point increase from the USD 208,333 per every 0.1 percentage Year 5 64.00 11,666,667.00 point increase from the DLI IN00907237 ACTION 4.0Nikshay mechanisms devp for (i)deduplication (of patients&providers) & recol of diff provider types;(ii)reconcl of DBT DLI 10 payments through NIKSHAY vs pub financial mgt portal for NPY (Prior Result) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Text 14,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Only manual mechanism for deduplication of Baseline patients and providers in existence Prior Results 14,000,000.00 Year 1 0.00 Year 2 0.00 Page 19 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) Year 3 0.00 Year 4 0.00 Year 5 0.00 DLI IN00907238 ACTION 4.1.1 Development and approval of a multi-year RNTCP Human Resource Plan at CTD and state levels covering the Program DLI 11 States Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Text 10,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No human resource plan in existence Prior Results 0.00 MOHFW has developed & adopted RNTCP Human Year 1 10,000,000.00 Resources Plan Year 2 0.00 Year 3 0.00 Year 4 0.00 Year 5 0.00 Action: This DLI has been Revised. See below. Page 20 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) DLI IN00913877 ACTION 4.1.1 Development and approval of a multi-year RNTCP Human Resource Plan at CTD and state levels covering the Program DLI 11 States Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Text 10,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No human resource plan in existence Prior Results 0.00 MOHFW has developed & adopted RNTCP Human Year 1 10,000,000.00 Resources Plan Year 2 0.00 Year 3 0.00 Year 4 0.00 Year 5 0.00 Rationale: This restructuring will extend the Year 1 timeline to achieve DLI 4.1.1: Development and approval of a multi-year National Tuberculosis Elimination Plan (NTEP) human resource plan from October 2020 to January 29, 2021. The MOHFW has made substantial progress on all other DLI targets set for Year 1, but progress on the human resource plan DLIs has been impacted by the COVID-19 pandemic. The MOHFW had made substantial progress in developing a plan for NTEP human resources, but with the onset of the COVID-19 pandemic, MOHFW repurposed national and state NTEP staff to the emergency response. Key senior MOHFW staff leading the NTEP human resources review are now leading the national COVID-19 emergency response. In addition, the planned human resource assessment study, which aimed to collect qualitative and quantitative data to inform NETP human resource planning, was delayed because of COVID-19-related travel restrictions. Moreover, COVID-19 has affected TB notification patterns, as well as NTEP staff work scope and workload. Because the COVID-19 response is likely to be protracted, how the impacts of the pandemic can be addressed in the NTEP human resource plan Page 21 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) must be explored further. All these factors have slowed progress on the development of NTEP human resource plan, and subsequent DLIs designed to bridge human resource gaps as a key NTEP institutional reform. DLI IN00907239 ACTION DLI 12 4.1.2 Reduction of the staffing gap identified by the RNTCP Human Resource Plan for CTD and the Program States Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 40,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 Prior Results 0.00 Year 1 0.00 USD 571,429 per every 1 percentage Year 2 25.00 14,285,714.00 point reduction from the USD 571,429 per every 1 percentage Year 3 50.00 14,285,714.00 point reduction from the USD 571,429 per every 1 percentage Year 4 60.00 5,714,286.00 point increase from the p USD 571,429 per every 1 percentage Year 5 70.00 5,714,286.00 point increase from the p Page 22 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) DLI IN00907240 ACTION 4.2 Development and implementation of a performance-based management mechanism between the CTD and the DLI 13 Program States Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Text 29,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No performance-based mechanism in existence Prior Results 0.00 Year 1 9,000,000.00 USD 689,655 for each Program State in Year 2 3,448,277.00 which the mechanism is USD 689,655 for each Program State in Year 3 5,517,241.00 which the mechanism is USD 689,655 for each Program State in Year 4 5,517,241.00 which the mechanism is USD 689,655 for each Program State in Year 5 5,517,241.00 which the mechanism is Page 23 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) ANNEX 2: PROGRAM ACTION PLAN . . PAP_NOT_CHANGE_TBL Action Description Source DLI# Responsibility Timing Completion Measurement Annual surveillance system analysis published; including data quality by district, annual state/CTD surveillance Annual Surveillance System system evaluation, Analysis Report Approved by the and estimates for Bank. potential under- notification and duplication Technical DLI Yes CTD Recurrent Yearly Achieved for Year 1 GOI and World Bank agree to a multi-year capacity building plan Capacity Building Plan Approved Capacity Building by MOH&FW AS. Due Date: Plan executed October 30, 2020 (Revised); annually Technical CTD Recurrent Yearly Yearly Execution Central, State and District TB Forum strengthened to improve learning and Government approval of the accountability. revised TORs for State and Central, State and National TB For a. District TB forum Due Date: Oct. 30, 2020 (CTD strengthened per shares final TORs with the Bank the TOR agreed to for review and clearance); Annual with the World Fora in Program States and at CTD Bank. by the following: June 30, 2020; Technical States and CTD Recurrent Yearly 21; 22; 23; 24 CTD Strengthens Data Collection and Monitoring of Data Collection and Monitoring Tribal Population Plan for Tribal Populations Transport Reimbursement. Annual TB Report with data on - Annual CTD DBT for Tribal Populations report which capture coverage Technical CTD Recurrent Continuous Page 24 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) and trends in DBT for tribal populations Development and adoption of framework for TB Framework for TB Among Women and gender in a Adopted by CTD for Program manner and Management Purposes. substance Gender specific data for TB satisfactory to the monitoring reported by CTD in Bank. Other CTD Due Date 30-Sep-2020 annual reports. The CTD formulates and adopts health and safety guidelines Health and Safety Guidelines for for staff/workers Sputum Transportation Published involved in the on RNTCP website and transport of disseminated to State TB Offices sputum Technical CTD Due Date 30-Sep-2020 for implementation Servicing Standard Operating Procedures of key lab equipment (BSC, AHU, centrifuge, autoclaves) [only where there is health and safety Standard operating procedures implications for for lab equipment published on workers] RNCTP websites and disseminated Technical CTD Due Date 30-Sep-2020 to states Process evaluation of the implementation and effect of DBT on adherence to Process Evaluation Report. Due TB treatment and Dates: June 30, 2021; June 30, success rate. Technical CTD Due Date 30-Jun-2021 2023 Operating Procedures for Grievance Redressal developed and adopted by CTD in a manner and substance satisfactory to the Approved Grievance Redressal Bank Technical CTD Due Date 30-Oct-2020 Policy Page 25 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) Strengthen the capacity of Central Medical Services Society (CMSS) to manage the procurement and supply chain a) Filling the 5 vacant staff management for positions & maintain full staff drugs and strength thereafter; equipment in line (b) Expanding number of with increased laboratories to conduct post workload destination quality assurance emanating from (presently 5 labs); & the Program. (c) enhancing CMSS/Supplier Fiduciary Systems CMSS Due Date 30-Oct-2020 interface & overall proc. effic Decentralize data entry on TB drug stock in the Nikshay Aushadhi Nikshay Aushadi data entry software at TU decentralized to TU levels in level. Fiduciary Systems CTD Due Date 30-Oct-2020 targeted states. Ensure proper testing by empaneled independent Quality Assurance Lab and monitor the time taken by the labs Technical CMSS and CTD Recurrent Yearly Drug quality testing report Implementation of PFMS to monitor and track real time fund utilization, including preparation of expenditure reports from PFMS, in a manner Expenditure reports produced and substance from PFMS. Initial report due satisfactory to the date: September 30, 2020; Yearly Bank. Fiduciary Systems CTD and states Recurrent Yearly execution Regular FM review by CTD of the state and district TB cells, pursuant to scope, protocols and FM review completed. Initial standards agreed Review: September 30, 2020. with the Bank. Fiduciary Systems CTD and States Recurrent Semi-Annually Execution every 6 months Scale-up RNTCP Contract effective and staff in call center from 50 Technical CTD Due Date 30-Jun-2019 place for 100 seat call centers. Page 26 of 27 The World Bank Program Towards Elimination of Tuberculosis (P167523) to 100 seats Updated supervision and monitoring guidelines to include integration of routine assessment and improvement of data completeness and quality in a Updated supervision and manner and monitoring guidelines to include substance integration of routine assessment satisfactory to the and improvement of data Bank. Technical CTD Due Date 31-Dec-2020 completeness and quality Beneficiary Satisfaction Survey as the TOR agreed Beneficiary Satisfaction Survey with the World Report. First survey due dt. Bank. Other CTD Recurrent Semi-Annually September 30, 2020 Strengthen RNTCP Guidelines to include protocols/standar d operating procedures for standardization in servicing and Standard operating procedures replacing/decomm for lab equipment published on issioning key lab RNTCP website and disseminated safety equipment Technical CTD Due Date 31-Dec-2019 to states. Update the Tribal Action Plan in a manner and substance Updated Tribal Action Plan satisfactory to the approved at CTD and Bank Other CTD Due Date 31-Dec-2020 disseminated to states. . Page 27 of 27