The World Bank Report No: ISR11459 Implementation Status & Results Argentina Essential Public Health Functions Programs II Project (P110599) Public Disclosure Copy Operation Name: Essential Public Health Functions Programs II Project Project Stage: Implementation Seq.No: 6 Status: ARCHIVED Archive Date: 19-Jan-2014 (P110599) Country: Argentina Approval FY: 2011 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 20-Dec-2010 Original Closing Date 30-Jun-2016 Planned Mid Term Review Date 31-Dec-2013 Last Archived ISR Date 10-Jul-2013 Effectiveness Date 03-Aug-2011 Revised Closing Date 30-Jun-2016 Actual Mid Term Review Date 07-Jul-2014 Project Development Objectives Project Development Objective (from Project Appraisal Document) The PDOs are to: (i) improve the stewardship role of the federal public health system, through the strengthening of Essential Public Health Functions; and (ii) increase the coverage and clinical governance of Priority Public Health Programs Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Strengthen the Ministry of Health's (MSN) and Provincial Ministries' Stewardship Capacities and 123.20 Improve the Public Health Infrastruc ture. Improve Results of Public Health Priority Programs and the Provincial Level 322.00 Administration, Monitoring, and Evaluation 14.50 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status Overview The Project was approved by the board on December 20, 2010, and the loan was signed on April 11, 2011. Project became effective on August 3, 2011. Locations Page 1 of 8 The World Bank Report No: ISR11459 Country First Administrative Division Location Planned Actual Argentina Not Entered Provincia de Misiones Public Disclosure Copy Argentina Not Entered Provincia de Formosa Argentina Not Entered Ciudad Autónoma de Buenos Aires Argentina Not Entered Provincia de Entre Ríos Argentina Not Entered Provincia de Corrientes Argentina Not Entered Provincia de Buenos Aires Argentina Not Entered Provincia de Tucumán Argentina Not Entered Provincia de Tierra del Fuego, Antártida e Islas del Atlántico Sur Argentina Not Entered Provincia de Santiago del Estero Argentina Not Entered Provincia de Santa Fe Argentina Not Entered Provincia de Santa Cruz Argentina Not Entered Provincia de San Luis Argentina Not Entered Provincia de San Juan Argentina Not Entered Provincia de Salta Argentina Not Entered Provincia de Río Negro Argentina Not Entered Provincia del Neuquén Argentina Not Entered Provincia de Mendoza Argentina Not Entered Provincia de La Rioja Public Disclosure Copy Argentina Not Entered Provincia de La Pampa Argentina Not Entered Provincia de Jujuy Argentina Not Entered Provincia de Córdoba Argentina Not Entered Provincia del Chubut Argentina Not Entered Provincia del Chaco Argentina Not Entered Provincia de Catamarca Page 2 of 8 The World Bank Report No: ISR11459 Results Project Development Objective Indicators Public Disclosure Copy Indicator Name Core Unit of Measure Baseline Current End Target Increased kilograms of blood-plasma produced Number Value 33000.00 40876.00 40000.00 by MSN and provincial labs Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 Comments The blood program indicator achieved its final target two years in advance. All 24 provinces have signed agreements with Cordoba'sUniversity (a factory created to produce Plasma), to contribute with blood for the production of plasma for the industry. Increases would come due to a major number of donors or based on improvements in the practices. Reduction of the tobacco consumption Percentage Value 30.00 30.00 27.00 prevalence in adults 18-64 Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 Comments A new Risk Factor survey has been defined for 2014. However, prior data from the Global Adult Tobacco Survey (GATS) for Argentina published in May 2013, show that prevalence of smoking decreased to 22.1% in 2012. GATS is a nationally representative survey. Public Disclosure Copy At least 200 out of the 700 participating Number Value 0.00 1.00 200.00 municipalities certified as Health Responsible Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 Municipalities Comments This indicator has not made progress because of the political economy between MSN and Provinces.The Government has requested to review this indicator during the following missions. Page 3 of 8 The World Bank Report No: ISR11459 Increased percentage of certified departments Percentage Value 0.00 43.70 80.00 or local territories with satisfactory or highly Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 satisfactory epidemiological surveillance nodes Comments Indicator to be reviewed in (C2). Public Disclosure Copy upcoming missions. Increased percentage of children under one Percentage Value 93.60 93.30 95.00 year of age vaccinated with pentavalent Date 20-Dec-2010 25-Nov-2013 30-Jun-2016 vaccine. Comments The EPI Program is accelerating its implementation in areas of extreme difficulties and final data will be available in the next ISR . Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increased participation of provinces in training Number Value 0.00 22.00 24.00 of health personnel in public health Date 20-Dec-2010 31-Mar-2013 30-Jun-2016 Comments Indicator close to be achieved two years in advance. MOH offered in 2011 and 2012 a training on EPHF and since 2012 a Postgraduate course on Epidemiology with participants from all jurisdictions. Number of pilot studies with nutritional Number Value 0.00 0.00 2.00 sprinkles component (to reduce iron deficiency Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 anemia) Comments The indicator is not in line with any intervention of FESP II project. The Government Public Disclosure Copy requested its elimination in a Project's restructuring. Health personnel receiving training (number) Number Value 0.00 458.00 800.00 Date 31-Mar-2011 12-Dec-2013 30-Jun-2016 Comments Health personnel from the Provinces and MoH are Annually. MSN and Provinces receiving substantially increasing Public training in public health labs, health training in Project's blood banks, and vaccination selected functions and for more than 40hours. programs. There is a clear policy to increase the number Page 4 of 8 The World Bank Report No: ISR11459 of personnel receiving training in Public Health at the national level. Percentage of women between 35 and 64 Percentage Value 10.00 15.00 60.00 Public Disclosure Copy years old in the two pilot provinces benefiting Date 20-Dec-2010 31-Mar-2013 30-Jun-2016 from at least one HPV and/or cutology test Comments Health care lines have been provided by the health system. discussed and are initiating implementation. Final data corresponding to 2013 will be available in the next ISR when end-of-year data becomes available. Increased number of PROFE population from Number Value 0.00 1044.00 4000.00 Tucuman and Misiones enrolled in a clinical Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 governance program for kidney disease Comments Study was concluded, and prevention and control. implementation process has initiated. From 1044 patients, 574 correspond to the province of Misiones and 470 to Tucuman. Number of intensive health care units Number Value 0.00 145.00 400.00 evaluated and properly registered in the Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 system. Comments Certification instrument has been approved, and will be applied during this year. Blood donations per 1000 inhabitants over 18 Percentage Value 25.60 29.00 30.60 years old Date 20-Dec-2010 30-Apr-2013 30-Jun-2016 Comments Ratio Important advances. Following trend, target will be achieved before the Project's end. Public Disclosure Copy Percentage of operational HIV/AIDS Percentage Value 0.00 77.30 70.00 Counseling and Testing Centers. Date 20-Dec-2010 30-Jun-2013 30-Jun-2016 Comments First report showed impressive results. The 2015 target has been achieved. During June 2013, the HIV/ AIDS program revealed that 697 CEPAT are now under operation. Page 5 of 8 The World Bank Report No: ISR11459 Percentage of PROFE beneficiaries with low Percentage Value 0.00 37.00 50.00 incidence high cost diseases included in the Date 20-Dec-2010 12-Dec-2011 30-Jun-2016 PROFE health care chain. Comments 0 out of 2.132 Initial responses are positive Public Disclosure Copy and in 2013, 37% of PROFE beneficiaries were already included in PROFE's health chain. Percentage of PROFE newly diagnosed Percentage Value 0.00 39.00 80.00 patients with renal chronic dialysis evaluated Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 within six months of beginning dialysis. Comments After agreements between SINTRA and Incluir Salud there is substantive progress in this indicator. Percentage of PROFE renal chronic dialysis Percentage Value 0.00 15.00 80.00 patients evaluated and included in SINTRA. Date 20-Dec-2010 31-Mar-2013 30-Jun-2016 Comments First evaluation are showing initial good results. Number of PROFE women with more than 7 Number Value 0.00 8645.00 40000.00 children having signed their letter of rights. Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 Comments Pilot test has been launched. In spite of being far from final target, a great number of women have been reached by this intervention, which has demanded substantive efforts from the Program. Number of tobacco free municipalities. Number Value 0.00 4.00 140.00 Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 Comments The National Program and provincial teams are working Public Disclosure Copy together in the process of certifying municipalities as tobacco free. A recent survey found that 225 municipalities already count on municipal legislation in line with the requirements. Gov. will present results 2014. Page 6 of 8 The World Bank Report No: ISR11459 Number of technical audits on clinical Number Value 0.00 0.00 2.00 effectiveness of the diseases of low incidence Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 and higher cost, renal disease and Comments Technical audit system is haemophilia. Public Disclosure Copy under preparation. TORs for the audit of clinical governance have been approved and the first audit for ERC and Gaucher is underway. Health facilities constructed, renovated, and/or Number Value 0.00 0.00 12.00 equipped (number) Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 Comments Process have been initiated and PAC has been updated according to recent modifications in the works plan. Percentage of women betweeen 40 and 69 Percentage Value 0.00 8.60 60.00 years old in the two pilot provinces benefitting Date 20-Dec-2010 12-Dec-2013 30-Jun-2016 from at least one mammography provided by Comments health care lines have been the health system discussed and are initiating implementation. Final data corresponding to 2013 will be available in the next ISR when end-of-year data becomes available. Data on Financial Performance (as of 09-Dec-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P110599 IBRD-79930 Effective 20-Dec-2010 11-Apr-2011 03-Aug-2011 30-Jun-2016 30-Jun-2016 Public Disclosure Copy Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P110599 IBRD-79930 Effective USD 461.00 461.00 0.00 274.58 186.42 60.00 Disbursement Graph Page 7 of 8 The World Bank Report No: ISR11459 Public Disclosure Copy Key Decisions Regarding Implementation The Project is progressing towards the Project Development Objectives (PDO) as measured by three out of five PDO indicators. The PDO indicator – Increased kilograms of blood- plasma produced by National Ministry of Health (MSN) Blood Program, and provincial labs, achieved 41.400 kg as of December 2013, surpassing end of Project target of 40.000 kg. As of December 11, 2013, almost two years after Project's effectiveness, 60% of loan proceeds have been disbursed using Results-based Financing mechanisms (RBF), including "insurance - premiums" (capita) and output-based disbursements. Two project pilots on Non Communicable Diseases (NCD's) in Tucuman and Misiones Provinces, aimed at implementing innovations on NCD's, have already initiated. Restructuring History There has been no restructuring to date. Related Projects Public Disclosure Copy There are no related projects. Page 8 of 8